Treatment of hemodialysis-induced hypotension with oral droxidopa

Hemodialysis (HD)-induced hypotension (HIH) is a serious complication in patients with maintenance HD therapy. Droxidopa (DOPS), a synthetic precursor amino acid of norepinephrine (NE), had already been found to be effective for hypotensive episodes of amyloidosis or Shy-Drager syndrome. We have reported its efficacy for HIH in some patients in our center. In this study, we evaluate the clinical effect in a multicenter trial. The subjects were 34 cases (male 14, diabetic renal failure 12) with HIH in 5 HD centers. DOPS (200-400mg) was administered orally 1 hr before the initiation of HD. The clinical effect of DOPS was evaluated on the basis of its prevention of HIH, the volume of saline or 10% NaCl and other treatments for HIH, and the improvement of subjective or objective symptoms. With DOPS administration, HIH improved in 23 cases (67.6%). The symptoms due to HIH improved in 25 cases (73.5%). The volume of administered saline or 10% NaCI for HIH decreased significantly. Furthermore, subjective improvement continued even after the HD session was completed in 22 cases (64.7%). Although mild side effects occurred in 3 cases, these disappeared after the dosage was decreased. There was no definite difference in the efficacy of DOPS related to the patients' age, sex, length of HD, the level of NE before the initiation of HD, though DOPS was less effective for diabetic or severe HIH patients. In conclusion, oral DOPS therapy was very effective for HIH, especially in non-diabetic patients.