Chronic hypotension, volume nonresponsive, is not rare in hemodialysis patients and is usually refractory to various therapies. Midodrine hydrochloride is an alpha-mimetic drug acting directly on the peripheral alpha-receptor and increases blood pressure. We studied 10 uremic patients on hemodialysis with chronic hypotension to evaluate efficacy and safety of midodrine. Midodrine hydrochloride was administered at a dose of 2.5 mg twice on the dialytic day, 1.25 mg twice on the nondialytic day. Subjective symptoms and objective parameters were evaluated and compared before and after midodrine treatment. Midodrine significantly increased systolic pressure from 73.0 +/- 10.5 mm Hg to 90.5 +/- 12.3 mm Hg (p < 0.01); and diastolic blood pressure from 44.0 +/- 8.4 mm Hg to 55.4 +/- 7.9 mm Hg (p < 0.01) before dialysis. Orthostasis, dizziness, fatigue, blurred vision, dullness, headache, and depression improved an average of 62%. All patients tolerated midodrine treatment well. Only mild side effects were noted, including flush sensation, neck soreness, and headache. We conclude that midodrine may be another choice for uremic patients on hemodialysis with chronic hypotension which responds poorly to other conventional management.