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  • Effects of ivabradine on the prevention of intradialytic hypotension in a dialytic patient with heart failure with reduced ejection fraction

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Case report
Effects of ivabradine on the prevention of intradialytic hypotension in a dialytic patient with heart failure with reduced ejection fraction
  1. Yusuke Nakano,
  2. Hirohiko Ando,
  3. Wataru Suzuki and
  4. Tetsuya Amano
  1. Department of Cardiology, Aichi Medical University, Nagakute, Japan
  1. Correspondence to Dr Yusuke Nakano; nakanoy{at}aichi-med-u.ac.jp

Abstract

A 65-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) and renal failure was admitted due to difficulty in fluid volume control during haemodialysis. He had frequent episodes of intradialytic hypotension (IDH) with presyncope during haemodialysis despite using a vasopressor agent. Before haemodialysis, his blood pressure was 130–150/60–70 mm Hg, and his heart rate was 80–100 beats/min. There were no specific causes of IDH. For refractory IDH, he was treated with oral ivabradine (2.5 mg two times per day), which resulted in reduced heart rate and decreased occurrence of IDH. This is the first report to describe a dialysis case with HFrEF presenting with an elevated heart rate and impaired fluid management as manifested by recurring IDH, which improved after ivabradine treatment. Ivabradine therapy may assist in increasing stroke volume by lowering the sinus heart rate, thus resulting in the prevention of IDH.

  • heart failure
  • cardiovascular system
  • renal system
  • dialysis

https://doi.org/10.1136/bcr-2021-246011

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    Footnotes

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    • Contributors All authors have contributed equally to the scientific content of this work (see below) and have edited the manuscript appropriately. (1) YN: analysis and interpretation of patient’s data, conception and design, drafting of the manuscript critically. (2) HA: conception and design, revising manuscript. (3) WS: analysis and interpretation of patient’s data, drafting of the manuscript critically. (4) TA: revising manuscript, final approval of the manuscript submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests YN reported receiving lecture fees from Ono Pharma Co, Ltd, AstraZeneca, Otsuka Pharma Co, Ltd, and Novartis Pharma Co, Ltd. TA reported receiving lecture fees from Astellas Pharma Co, Ltd, AstraZeneca, Daiichi Sankyo, Otsuka Pharma Co, Ltd, and Novartis Pharma Co, Ltd. The remaining authors have no conflict of interest to report.

    • Provenance and peer review Not commissioned; externally peer reviewed.