TY - JOUR
T1 - The Safety and Efficacy of Clonidine in Hemodialysis Patients
T2 - A Systematic Review and Meta-Analysis
AU - Derk, Gwendolyn
AU - Barton, Amy
AU - An, Ruopeng
AU - Fang, Hsin Yu
AU - Ashrafi, Sadia Anjum
AU - Wilund, Ken
N1 - Publisher Copyright:
© 2022 S. Karger AG. All rights reserved.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background: Clonidine is a frequently prescribed long-Term antihypertensive medication in hemodialysis (HD) patients in the USA, but its safety and efficacy has not been clearly established in the HD population. Objective: To evaluate, we conducted a systematic review and meta-Analysis on the safety and efficacy of clonidine in HD patients. Methods: Keyword search of "clonidine"and "dialysis"was conducted through April 2021 in PubMed, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov databases. Inclusion criteria were as follows-study design: randomized controlled trials, cohort studies, prospective studies, retrospective studies, or case series; subjects: Adult HD patients; main outcome: blood pressure (BP) and safety; language: English; and article type: peer-reviewed publications. Studies that examined the effects of clonidine in populations other than adult HD patients were excluded. Meta-Analysis was performed on BP reduction outcomes. Results: Eight studies met the inclusion criteria for the systematic review, including prospective pre-post studies (2), double-blind controlled trial (1), single-blinded placebo-controlled trial (1), crossover open-label clinical trial (1), retrospective analysis (1), and case report series (2). Three studies included in the meta-Analysis ranged from 2 to 12 weeks duration, with a collective sample size of 24 (ages 12-77 years). Risk of bias, assessed using the ROBINS-1 tool, was high for all included studies. Significant adverse effects reported included hypotension, light-headedness, drowsiness, dry mouth, rebound hypertension, and contact dermatitis from patch application. Short-Term clonidine use was associated with significant improvement in systolic BP (pooled effect:-12.985 mm Hg, 95% CI [-7.878,-18.092], p < 0.001), while changes in diastolic BP were not statistically significant (-11.119 mm Hg, 95% CI [-22.725, 0.487], p = 0.060). No data currently support the long-Term efficacy of clonidine in HD patients. This study was unfunded and was developed using PRISMA guidelines and registered on PROSPERO (CRD42018112042). Conclusions: There is no evidence supporting the long-Term use of clonidine in the HD population and a significant side-effect profile. There is low-quality evidence demonstrating the efficacy of clonidine in lowering BP in HD patients in short-Term use, but significant safety concerns remain. Fluid removal strategies and other antihypertensives should be used over clonidine for long-Term BP control in the HD population.
AB - Background: Clonidine is a frequently prescribed long-Term antihypertensive medication in hemodialysis (HD) patients in the USA, but its safety and efficacy has not been clearly established in the HD population. Objective: To evaluate, we conducted a systematic review and meta-Analysis on the safety and efficacy of clonidine in HD patients. Methods: Keyword search of "clonidine"and "dialysis"was conducted through April 2021 in PubMed, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov databases. Inclusion criteria were as follows-study design: randomized controlled trials, cohort studies, prospective studies, retrospective studies, or case series; subjects: Adult HD patients; main outcome: blood pressure (BP) and safety; language: English; and article type: peer-reviewed publications. Studies that examined the effects of clonidine in populations other than adult HD patients were excluded. Meta-Analysis was performed on BP reduction outcomes. Results: Eight studies met the inclusion criteria for the systematic review, including prospective pre-post studies (2), double-blind controlled trial (1), single-blinded placebo-controlled trial (1), crossover open-label clinical trial (1), retrospective analysis (1), and case report series (2). Three studies included in the meta-Analysis ranged from 2 to 12 weeks duration, with a collective sample size of 24 (ages 12-77 years). Risk of bias, assessed using the ROBINS-1 tool, was high for all included studies. Significant adverse effects reported included hypotension, light-headedness, drowsiness, dry mouth, rebound hypertension, and contact dermatitis from patch application. Short-Term clonidine use was associated with significant improvement in systolic BP (pooled effect:-12.985 mm Hg, 95% CI [-7.878,-18.092], p < 0.001), while changes in diastolic BP were not statistically significant (-11.119 mm Hg, 95% CI [-22.725, 0.487], p = 0.060). No data currently support the long-Term efficacy of clonidine in HD patients. This study was unfunded and was developed using PRISMA guidelines and registered on PROSPERO (CRD42018112042). Conclusions: There is no evidence supporting the long-Term use of clonidine in the HD population and a significant side-effect profile. There is low-quality evidence demonstrating the efficacy of clonidine in lowering BP in HD patients in short-Term use, but significant safety concerns remain. Fluid removal strategies and other antihypertensives should be used over clonidine for long-Term BP control in the HD population.
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U2 - 10.1159/000525424
DO - 10.1159/000525424
M3 - Article
C2 - 36075189
AN - SCOPUS:85139698642
SN - 0031-7012
VL - 107
SP - 545
EP - 555
JO - Pharmacology
JF - Pharmacology
IS - 11-12
ER -