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

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          Abstract

          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

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              Author and article information

              Journal
              NEF
              Nephron
              10.1159/issn.1660-8151
              Nephron
              S. Karger AG
              1660-8151
              2235-3186
              2002
              April 2002
              08 April 2002
              : 90
              : 4
              : 384-390
              Affiliations
              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
              Article
              54725 Nephron 2002;90:384–390
              10.1159/000054725
              11961396
              © 2002 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 3, Tables: 4, References: 13, Pages: 7
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/54725
              Categories
              Original Paper

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