혈액투석시 저혈압에 대한 Sertralin의 효과

Effect of Sertralin Hydrochloride on Dialysis Hypotension

Background: Intradialytic hypotension is a disabling complication in end-stage renal disease(ESRD) and has a multifactorial etiology. Autonomic dysfunction occurs in up to 50% of patients with end-stage renal disease(ESRD) and plays a key role in intradialytic hypotension in some patients. Sertralin hydrochloride, a central nervous system serotonin reuptake inhibitors, has been shown to be an effective treatment of hypotension caused by autonomic dysfunction. Aim of this study is to determine whether sertralin is effective in ameliorating intradialytic hypotension. Methods: This study was prospective that included 7 consecutive patients who had intradialytic hypotension. The data from 4-week pre-sertralin period were compared with the data from a 4 week sertralin period. The patients were given a 50 mg of sertralin 30 minutes before each hemodialysis session. Results : There was a statistically significant improvement in lowest intradialytic systolic blood pressure (from $115.4{\pm}22.6$ to $124.1{\pm}20.7$ mmHg, P=0.003), lowest intradialytic dialstolic blood pressure ( from $68.8{\pm}14.9$ to $72.9{\pm}11.8$ 11.8 mmHg, P=0.02), lowest intradialytic mean arterial pressure( from $83.3{\pm}17.1$ to $89.3{\pm}13.8$ mmHg, P=0.004), post-hemodialysis systolic pressure(from $142.1{\pm}22.5$ to $149.5{\pm}22.1$ mmHg P=0.007), post-hemodialysis diastolic pressure(from $79.3{\pm}10.7$ to $83.2{\pm}9.6$ mmHg, P=0.002), post-hemodialysis mean arterial pressure(from $100.3{\pm}13.3$ to $105.3{\pm}12.4$ mmHg, P=O.OO1) during sertralin period. In addition, the number of symptomatic hypotensive episodes per dialysis session during the sertralin period significantly was lower than that during the pre-sertralin period( mean $0.45{\pm}0.5$ episodes per session vs $0.13{\pm}0.3$ episodes per session; P<0.05). Conclusions: It is concluded that the short-term (4 weeks) use of sertralin hydrochloride reduces intradialytic hypotension in ESRD patients.