Midodrine is an oral alpha agonist that helps prevent intra dialytic hypotension.
What is the evidence that midodrine works for hypotension? Is there any? A nice review was published in NDT few years ago. Here is the summary. A meta analysis was done.
Observational studies, randomized controlled trials, crossover studies and pre- and post-intervention design studies with dialysis patients were included. Thirty-seven full text articles were retrieved and nine met the selection criteria, in addition to one unpublished study. Midodrine dosing regimens ranged from 2.5 to 10 mg of midodrine given 15–30 min pre dialysis. Post-dialysis systolic blood pressure was higher by 12.4 mmHg and diastolic pressure was higher by 7.3 mmHg during treatment vs. control. Six of 10 studies report improvement in symptoms of IDH, and there were no reported serious adverse events ascribed to midodrine.
This review points out that midodrine has a role in the therapy of hemodialysis patients experiencing IDH. Although not any of these studies had that big of a sample size. FDA just issued a warning that this drug be take away from the market. This is due to lack of Class I or II evidence for overall treatment of cardiac and renal diseases. Check out the FDA website.
Here is the review to the article