Original Paper

Effect of Sertraline Hydrochloride on Cardiac Autonomic Dysfunction in Patients with Hemodialysis-Induced Hypotension
Ahmet Ugur Yalcin^a, Gulmira Kudaiberdieva^b, Garip Sahin^c, Bulent Gorenek^b, Nevbahar Akcar^d, Serhat Kuskus^b, Figen Bayrak^e, Bilgin Timuralp^b

Departments of
^aNephrology,
^bCardiology,
^cInternal Medicine, and
^dRadiology, Osmangazi University Medical School, and
^eONVAK Hemodialysis Center, Eskisehir, Turkey

Address of Corresponding Author

Nephron Physiol 2003;93:p21-p28 (DOI: 10.1159/000066655)

  Key Words

• Hemodialysis-induced hypotension
• Complication of hemodialysis
• Autonomic dysfunction
• Heart rate variability
• Head-up tilt
• Sertraline hydrochloride
• Serotonin re-uptake inhibitors

  Abstract

Background/Aims: It was previously shown that sertraline hydrochloride treatment improved hemodynamic parameters of patients with dialysis induced hypotension (DIH). The aim of this study was to examine the effect of sertraline on the autonomic functions of patients with DIH. Methods: Ten patients with DIH, 10 hemodialysis patients without DIH and 10 healthy control subjects were included into the study. All of the patients were treated with sertraline 50 mg per day for 4 weeks. Pre-treatment and post-treatment heart rate variability (HRV) in supine and tilt position was evaluated. In order to evaluate the autonomic response to tilt position, gap values were calculated by subtracting the HRV in supine position from the HRV in tilt position. Results: Analysis of the HRV response to tilt, demonstrated a paradoxical reduction in the indices of sympathetic modulation and sympathovagal balance in the patients with DIH while there was an increase in normalized powers of low frequency components (LFNU) and low frequency to high frequency components ratio (LFP/HFP) in the patients without DIH and control group. The number of therapeutic interventions for restoration of DIH decreased significantly in the sertraline period (p < 0.001). The gap values of the patients with DIH in LFNU (sympathetic modulation) (p < 0.05) and LFP/HFP (sympathovagal balance) increased in the sertraline period (p < 0.01). The decrease in gap value of normalized powers of high frequency components (parasympathetic modulation) was pronounced in the sertraline period in the patients with DIH (p < 0.05). Conclusion: The preventive effect of sertraline on DIH might be related to the improvement of regulation of autonomic response to hypovolemia.

Copyright © 2003 S. Karger AG, Basel

  Author Contacts

Ahmet Ugur Yalcin
Visnelik Mah Karatay Sok Celikyurek Apt A Blok 7/22 26010
Eskisehir (Turkey)
Tel. +90 222 2260292, Fax +90 222 2394949 or +90 222 2393774
E-Mail auyalcin@ogu.edu.tr

  Article Information

Received: April 4, 2002
Accepted: July 31, 2002
Number of Print Pages : 8
Number of Figures : 1, Number of Tables : 3, Number of References : 32