Study of Oral Melatonin on Sleep Quality and Blood Pressure in Patients on Maintenance Hemodialysis

Background: The night time secretion of melatonin is significantly impaired in CKD patients. Melatonin supplementation is found to improve sleep disorders and lower the BP in essential hypertension. This study strives to extrapolate the effect of melatonin on sleep quality, depression and BP in maintenance hemodialysis patients Methods: This was a single-centre, Non Randomised open label single arm interventional trial.Maintenance hemodialysis patients of age18 -75 years with dialysis vintage>1 year and baseline Pittsburgh Sleep quality index (PQSI) >5 were selected. 24 hour ambulatory BP and Depression scoring using DASS21 questionnaire done prior to melatonin supplementation. Oral Melatonin was given at a dose of 5 mg one hour before bedtime for 3 months. Results: A total of 30 patients were studied, of whom 23 were male(76.7%). All were on antihypertensive drugs (mean 2.3 ± 1.15) with one drug being Nifidipine.The dialysis frequency was twice weekly in 20 patients(66.7%) and thrice weekly in 10 patients(33.3%). Melatonin shows significant improvement in sleep and depression scores.The systolic BP does not change significantly but we observed an increase in the Diastolic BP post melatonin ( p value <0.05) [Figure 1] and is contradictory to our hypothesis of BP lowering effect of melatonin. The change in the nighttime dipping status post melatonin was not significant (p value 0.87). But a decrease in the systolic BP surge in early morning was noted(p value 0.03) Conclusion: Melatonin has significant benefit in improving sleep quality and depression in hemodialysis patients. But their effect on blood pressure needs further studies with due considerations for drug interaction with calcium channel blockers.