Prevention of intradialytic hypotensive episodes: is setraline an effective pharmacological approach?

Intradialytic Hypotension Pathophysiology and Therapy Update: Review and Update

BackgroundIntradialytic hypotension (IDH) is the most prevalent complication during hemodialysis (HD) sessions, affecting 10% to 12% of patients. It is linked with temporary ischemic stress in vital organs, increasing patient mortality. Various definitions of IDH have been proposed, and a strong correlation has been found between patient outcomes and the absolute lowest systolic blood pressure. The most probable underlying pathophysiology of IDH involves a reduced effective blood volume and decreased plasma tonicity. Optimizing the dialysis prescription and interventions during and after the dialysis session is sometimes effective for reducing IDH risk.Aim and MethodThis review discusses the pathophysiology, prevention, and therapy of IDH updates. To achieve this aim, Scopus, EMBASE, PubMed, Google, and Google Scholar were searched for articles published in the last two decades using phrases and keywords.ConclusionIntradialytic pathophysiology is ambiguous and unclear. The evidence for the effectiveness of the known therapies and maneuvers is limited. Ideally, IDH prevention should be the target; however, IDH management is sometimes needed. Different obstacles require further clinical research.

Use of Sertraline in Hemodialysis Patients

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.