Abstract
Introduction: Although some studies have reported the positive effect of sertraline and L-carnitine on intradialytic hypotension (IDH), a common complication of dialysis, however the results are controversial. Objectives: The aim of this study was to compare the effects of sertraline and L-carnitine on blood pressure in patients with chronic renal failure who were undergoing dialysis. Patients and Methods: This double-blind clinical trial was conducted on 32 hemodialysis patients who suffered from IDH in more than 50% of dialysis sessions. Patients were randomly divided into two groups of sertraline (50 mg daily) and L-carnitine (1000 mg daily), with 16 patients in each group. Duration of treatment was four weeks, then patients were followed up for additional three weeks. The changes in patients’ blood pressure were monitored in each group and the results compared between the two groups. Results: Of all, 18 patients (56%) were female, 14 patients (44%) were male, and their mean (SD) age was 60±15 years. At the end of the study, mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), and mean arterial pressure (MAP) were significantly increased in both the sertraline and L-carnitine groups (P<0.05). In addition, nadir SBP, nadir DBP, and nadir MAP in each group were significantly increased compared to pre-treatment period (P<0.001). An increase of more than 5 mm Hg in SBP, DPB, and MAP was observed in half of the subjects in the sertraline group and more than two-thirds of the patients in the L-carnitine group, however there was no significant difference between the two groups (P>0.05). Conclusion: The findings of this study showed that the administration of sertraline or L-carnitine for one month could significantly increase SBP, DBP, MAP, and nadir blood pressures in dialysis patients suffering from IDH during dialysis sessions because there was no significant difference between the two drugs.
Highlights
Some studies have reported the positive effect of sertraline and L-carnitine on intradialytic hypotension (IDH), a common complication of dialysis, the results are controversial
Implication for health policy/practice/research/medical education: In a double blind clinical trial on 32 hemodialysis patients who suffered from intradialytic hypotension, in more than 50% of dialysis sessions, we found that the administration of sertraline or L-carnitine for one month could significantly increase the mean systolic blood pressure, mean diastolic blood pressure, and mean arterial pressure and nadir blood pressures while there was no significant difference between both drugs
There was no significant difference between patients in the sertraline and L-carnitine groups regarding age, gender, height, weight, body mass index (BMI), diabetes, and hypotension at home (Table 1)
Summary
Some studies have reported the positive effect of sertraline and L-carnitine on intradialytic hypotension (IDH), a common complication of dialysis, the results are controversial. Conclusion: The findings of this study showed that the administration of sertraline or L-carnitine for one month could significantly increase SBP, DBP, MAP, and nadir blood pressures in dialysis patients suffering from IDH during dialysis sessions because there was no significant difference between the two drugs. Repeated episodes of IDH are associated with increased morbidity and morbidity in patients [5,6] and may decrease the effects of dialysis because such a condition may make it necessary to modify treatment and stop dialysis. In severe cases, it can be associated with intestinal ischemia, stroke or myocardial infarction and fistula thrombosis [3,7]. IDH usually occurs in the absence of serious medical monitoring and may emerge because of several factors such as rapid or excessive ultrafiltration, rapid decrease in plasma osmolarity, incorrectly low-prescribed target weight, autonomic neuropathy, and use of pre-dialysis anti-hypertensive medications or meals during the dialysis session, and the composition and temperature of the dialysate fluid [2,3,8]
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