The Effects of Sertraline on Dialysis-Induced Hypotension: A Systematic Review and Meta-Analysis

Background/Objectives: Dialysis-induced hypotension (DIH) affects 10-30% of hemodialysis sessions and increases mortality. Sertraline may stabilize blood pressure by modulating the Bezold-Jarisch reflex. We aimed to evaluate the efficacy and safety of sertraline for preventing DIH. Methods: We searched PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov through December 2025. Random-effects meta-analysis was performed using standardized mean differences (SMD). Results: Nine studies (140 patients) met inclusion criteria. Sertraline significantly increased mean arterial pressure (SMD: 0.87; 95% CI: 0.52-1.22; p < 0.001), corresponding to approximately 8.5 mmHg. DIH episodes decreased by 35% (RR: 0.65; 95% CI: 0.48-0.88). Heterogeneity was moderate (I² = 42%). Among studies reporting safety data (n = 106), adverse events were mild (14%) with no serious events. No publication bias was detected (Egger's p = 0.21). Conclusions: Sertraline significantly improves hemodynamic stability during hemodialysis with a favorable safety profile. It represents a promising option for DIH, particularly in patients with comorbid depression or contraindications to midodrine.