Haemodynamic effects of prenalterol in patients on dialysis

Haemodialysis hypotension occurs with particular frequency in bilateral nephrectomised patients. This reflects the importance of the renin-angiotensin-aldosterone system for maintaining normal blood pressure. Failure of vascular access (due to clotting and thrombosis of shunts) and ischaemic necrosis of transplanted kidneys in hypotensive patients prompted us to treat them orally with a new beta 1-adrenergic agent (prenalterol). Blood pressure was normalised in 4 out of 5 patients. Because of delayed renal elimination of the drug, daily dosage must be reduced to prevent symptoms of adrenergic stimulation. A study of the pharmacokinetics of prenalterol in uraemia is in preparation.