Methylene blue, a nitric oxide inhibitor, prevents haemodialysis hypotension

Gary Peer, Elena Itzhakov, Yoram Wollman, Tamara Chernihovsky, Itamar Grosskopf, David Segev, Donald Silverberg, Miriam Blum, Doron Schwartz, Adrian Iaina

Research output: Contribution to journalArticlepeer-review


Background. Plasma nitric oxide (NO) levels have been found to be high in haemodialysis (HD) patients, especially in those prone to hypotension in dialysis. The aim of the study was to prevent dialysis hypotension episodes by i.v. administration of methylene blue (MB), an inhibitor of NO activity and/or production. Methods. MB was given i.v. in 18 stable HD patients with hypotensive episodes during almost every dialysis, in 18 HD patients without hypotension during dialyses, and in five healthy controls. MB was given as a bolus of 1 mg/kg bodyweight followed by a constant infusion of 0.1 mg/kg bodyweight lasting 210 min until the end of the dialysis session and only as a bolus on a non-dialysis day. Systolic and diastolic blood pressures (BP) were measured at 10-min intervals during HD sessions with or without MB and on a non-dialysis day with MB. Results. In hypotension-prone patients, MB completely prevented the hypotension during dialysis and increased both systolic and diastolic BP on non-dialysis days. In normotensive patients, MB increased BP during the first hour of dialysis and for 90 min on the non-dialysis day. The BP in the healthy controls remained unchanged. Plasma and platelet NO2+NO3 (stable metabolites of NO) levels were determined. The NO2+NO3 generation rate in the first post-dialysis day was calculated. The plasma and platelet NO2+NO3 were higher in the hypotensive group than in the normotensive dialysis group. The generation rate of nitrates was higher (P<0.01) in the hypotensive group (1.21±0.13 μmol/min and 0.74±0.16 after MB) than in the normotensive patients (0.61±0.11 μmol/min and 0.27 ± 0.14 after MB). No side-effects were recorded. Conclusions. MB is an efficient therapy in the prevention of dialysis hypotension.

Original languageEnglish
Pages (from-to)1436-1441
Number of pages6
JournalNephrology Dialysis Transplantation
Issue number7
StatePublished - 2001
Externally publishedYes


  • Haemodialysis
  • Hypotension
  • Methylene blue
  • Nitric Oxide


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