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

Background: Dialysis-induced hypotension (DIH) affects 10-30% of hemodialysis sessions and is associated with increased mortality, loss of residual kidney function, and vascular access thrombosis. While midodrine is commonly used, it has significant contraindications in patients with coronary artery disease. Sertraline, a selective serotonin reuptake inhibitor (SSRI), may stabilize blood pressure by modulating the Bezold-Jarisch reflex. Objective: To evaluate the efficacy and safety of sertraline for preventing dialysis-induced hypotension in patients receiving maintenance hemodialysis. Methods: We will search PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception through December 2025. We will include randomized and non-randomized studies of adults on maintenance hemodialysis comparing sertraline to placebo, no treatment, or active comparators. Random-effects meta-analysis will be performed using standardized mean differences for continuous outcomes and risk ratios for binary outcomes. Primary outcome: Change in mean arterial pressure (MAP) during or after hemodialysis. Secondary outcomes: Systolic and diastolic blood pressure changes, frequency of DIH episodes, nursing interventions required, and adverse events.