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Long-term use of clonidine may not be safe for patients on hemodialysis

Issue: December 2018

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SAN DIEGO — Clonidine demonstrated short-term efficacy in lowering blood pressure in patients on hemodialysis; however, there was no evidence to support its long-term use and safety concerns, according to data presented at ANS Kidney Week, here.

“Clonidine is widely used in dialysis patients, with about 20% on the medication long-term,” Gwendolyn Derk, MD, from the University of Illinois, told Healio Nephrology.

Derk and colleagues performed a systematic review and meta-analysis of eight studies to investigate the safety and efficacy of clonidine for hypertension treatment in adult patients on hemodialysis. The duration of the studies ranged from 2 to 8 weeks.

The assessed studies were highly biased, Derk said.

The researchers identified several significant adverse events associated with oral and patch clonidine, including hypotension, lightheadedness, drowsiness, dry mouth, rebound hypertension and contact dermatitis. Short-term use of clonidine was associated with significant improvement in systolic BP, but not diastolic BP.

“There is no evidence supporting the long-term use of clonidine in hemodialysis patients,” Derk said. “We don’t have the evidence to be doing this and yet we are.”

“I believe there to be a potential for there to be a long-term effect of clonidine use that would not be positive, such as more fluid retention, more fluid overload and volume overload over time and likely worse cardiovascular outcomes,” she said.

Derk mentioned that she and her team are working on a protocol to deprescribe certain BP medications in dialysis patients.

“We are doing more harm than good by having these patients on this medication long-term and we should focus more on the volume control side to manage their BP rather than prescribing a medication,” she said. – by Alaina Tedesco

Reference:

Derk G, et al. Abstract: FR-PO358. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.

Disclosure: Healio Nephrology was unable to confirm relevant financial disclosures at the time of publication.