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      Clinical Effects of L-Threo-3,4-Dihydroxyphenylserine on Orthostatic Hypotension in Hemodialysis Patients

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          Orthostatic hypotension is one of the major factors interfering with everyday activities in hemodialysis patients, but there has been no effective agent for treating it. In order to clarify the clinical effects of L-threo-3,4-dihydroxyphenylserine ( L-DOPS) on orthostatic hypotension of hemodialysis patients, we conducted a randomized, double-blind comparative trial. 149 regular hemodialysis patients with orthostatic hypotension were randomly allocated to three groups and L-DOPS at doses of 400 mg, 200 mg or placebo was orally administrated to each group 30 min before starting every hemodialysis for 4 weeks. Changes of blood pressure (BP) in orthostatic hypotension immediately after completion of hemodialysis and symptoms related to orthostatic hypotension were compared between the three groups. In the 400-mg group, systolic and diastolic BP after standing increased significantly and the drop of mean BP after standing was also reduced compared with pretreatment levels. No such changes were observed in the placebo group. Fatiguability, malaise/weakness, dizziness and light-headed feeling, the interdialytic symptoms commonly observed in hemodialysis patients who developed orthostatic hypotension, were improved to a significant extent in the L-DOPS group compared with the placebo group. In particular, the improvement was more remarkable for the L-DOPS 400-mg group than the placebo group in patients with diabetic nephropathy, lower systolic BP after standing, and the long duration type of orthostatic hypotension. The incidence of adverse events was comparable between the three groups, and all recovered after discontinuation of L-DOPS or concomitantly administered drugs, or without any treatment. These findings indicate that L-DOPS taken before hemodialysis prevents orthostatic hypotension in patients undergoing hemodialysis, and is also effective for the interdialytic symptoms related to orthostatic hypotension.

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          Most cited references 2

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          Plasma norepinephrine, epinephrine, and dopamine levels in end-stage renal disease. Effect of hemodialysis.

           N. Vaziri,  M Maksy,  N. Elias (1985)
          The effect of hemodialysis on plasma norepinephrine (NE), epinephrine, and dopamine levels was studied in 11 patients undergoing maintenance hemodialysis. The results showed that the baseline plasma concentrations of NE and dopamine were significantly elevated in patients with end-stage renal disease undergoing maintenance hemodialysis. Intradialysis weight loss and fall in the serum glucose concentration during dialysis correlated with changes in plasma epinephrine and NE concentrations. Single-pass dialysis resulted in a marked reduction in the plasma NE concentration, indicating significant removal by dialysis. These observations should be taken into consideration when interpreting plasma catecholamine data obtained in the course of investigation of hypertensive patients with end-stage renal disease.
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            Studies on the activity of l-THREO-3,4-dihydroxyphenylserine (l-DOPS) as a catecholamine precursor in the brain comparison with that of l-DOPA


              Author and article information

              S. Karger AG
              April 2002
              08 April 2002
              : 90
              : 4
              : 384-390
              aWakayama Medical University, Wakayama City, bShowa University, Fujigaoka Hospital, Yokohama, cYodogawa Christian Hospital, Osaka, dTokyo Medical and Dental University, Tokyo, eTokyo Jikeikai Medical University, Tokyo, fKinki University Medical School, Osaka, gMasuko Memorial Hospital, Nagoya, hShinrakuen Hospital, Niigata, and iOsaka Prefectural Hospital, Osaka, Japan
              54725 Nephron 2002;90:384–390
              © 2002 S. Karger AG, Basel

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              Figures: 3, Tables: 4, References: 13, Pages: 7
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