Supplementary Material for: Effect of Fludrocortisone on Intradialytic Hypotension: An Open-Label, Randomized, Crossover Study

<b><i>Introduction:</i></b> Intradialytic hypotension (IDH) is an important complication during chronic hemodialysis due to its adverse cardiovascular and hemodialysis outcomes. Case reports have demonstrated that administration of fludrocortisone before undergoing hemodialysis might increase intradialytic blood pressure. This study is a randomized crossover study aiming to evaluate the intradialytic hemodynamic effects of fludrocortisone. <b><i>Material and Methods:</i></b> A randomized, controlled two-period crossover trial was conducted at Lampang Hospital in stable chronic hemodialysis patients who experienced IDH &gt;30% in their sessions during the past 3 months. All participants have randomly received a single dose of 0.2-mg fludrocortisone 30 min before each hemodialysis session, or had no treatment for 4 weeks. After a 2-week washout period, the participants were then switched to the other treatment for 4 weeks. The primary outcome was the mean lowest intradialytic mean arterial pressure (MAP) during the hemodialysis session. <b><i>Results:</i></b> A total of 17 patients were recruited with a mean age of 61.7 ± 14.8 years. By analysis of crossover design, the mean lowest intradialytic MAP was not different between receiving fludrocortisone or with no treatment (76.1 ± 12.5 vs. 73.9 ± 11.5 mm Hg, <i>p</i> for treatment effect = 0.331, <i>p</i> for period effect = 0.855, <i>p</i> for sequence effect = 0.870). There was no difference in the incidence of IDH between the two groups (34.4% in fludrocortisone vs. 42.7% in no treatment, <i>p</i> = 0.137). However, in diabetic patients and patients with residual kidney function, the incidence of IDH was significantly lower when receiving fludrocortisone (30.8 vs. 52.6%, <i>p</i> &lt; 0.001, and 27.6 vs. 74.3%, <i>p</i> &lt; 0.001, respectively). <b><i>Conclusions:</i></b> In chronic hemodialysis patients who had IDH, fludrocortisone administration did not improve intradialytic hemodynamics and did not decrease the incidence of IDH.

**引言：** 透析中低血压（Intradialytic hypotension, IDH）是慢性血液透析期间的重要并发症，因其可对心血管系统及血液透析结局产生不良影响。已有病例报告显示，在血液透析前给予氟氢可的松，或可提升透析期间的血压水平。本研究为一项随机交叉试验，旨在评估氟氢可的松对透析期间血流动力学的影响。
**材料与方法：** 本研究为随机对照两周期交叉试验，于南邦医院（Lampang Hospital）开展，纳入近3个月内每次透析疗程中出现透析中低血压（IDH）发生率＞30%的稳定型慢性血液透析患者。所有受试者被随机分配，在每次血液透析前30分钟单次服用0.2mg氟氢可的松，或不予任何治疗，干预周期均为4周。经过2周的洗脱期后，受试者将切换至另一干预方案，继续干预4周。本研究的主要结局指标为血液透析期间的最低平均动脉压（mean arterial pressure, MAP）平均值。
**结果：** 本研究共纳入17例受试者，平均年龄为61.7±14.8岁。通过交叉试验设计分析显示，服用氟氢可的松组与未治疗组的最低透析期间平均动脉压平均值无显著差异（76.1±12.5 vs. 73.9±11.5 mmHg，治疗效应P=0.331，周期效应P=0.855，序列效应P=0.870）。两组的透析中低血压发生率无显著差异（氟氢可的松组为34.4%，未治疗组为42.7%，P=0.137）。但在糖尿病患者及残余肾功能患者亚组中，服用氟氢可的松时的透析中低血压发生率显著更低（分别为30.8% vs. 52.6%，P<0.001；27.6% vs.74.3%，P<0.001）。
**结论：** 对于既往出现透析中低血压的慢性血液透析患者，给予氟氢可的松并未改善透析期间的血流动力学状态，也未降低透析中低血压的发生率。