Abstract
Rationale & Objective: There is conflicting evidence regarding the type of β-blockers to use in dialysis patients. This systematic review seeks to determine whether highly dialyzable β-blockers are associated with higher rates of cardiovascular events and mortality in hemodialysis patients than poorly dialyzable β-blockers. Study Design: A systematic review of the existing literature was conducted. A meta-analysis was performed using data from the selected studies. Setting & Study Populations: Participants were from the United States, Canada, and Taiwan. The mean ages of participants ranged from 55.9-75.7 years. Selection Criteria for Studies: We searched the Ovid MEDLINE database from 1990 to September 2020. Studies without adult hemodialysis participants and without comparisons of at least 2 β-blockers of different dialyzability were excluded. Data Extraction: Baseline and adjusted outcome data were extracted from each study. Analytical Approach: Random-effects models were used to calculate pooled risk ratios using fully adjusted models from individual studies. Results: Four cohort studies were included. Pooling fully adjusted models, highly dialyzable β-blockers did not influence mortality (HR, 0.94; 95% CI, 0.81-1.08; I2 = 0.84) compared with poorly dialyzable β-blockers but were associated with a reduction in cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93). There was significant heterogeneity between studies (I2 = 0.35). Only 1 study reported on adverse events. Intradialytic hypotension was more common in those on carvedilol (a poorly dialyzable β-blocker) compared with those on metoprolol (a highly dialyzable β-blocker; adjusted incidence rate ratio, 1.10; 95% CI, 1.09-1.11). Limitations: No randomized controlled trials were identified. Each study used different analytic methods and different definitions for outcomes. Classifications of β-blockers varied. Only 1 study reported on adverse events. Conclusions: Pooled data suggest highly dialyzable β-blockers are associated with similar mortality events and fewer cardiovascular events compared with poorly dialyzable β-blockers.
Original language | English (US) |
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Article number | 100460 |
Journal | Kidney Medicine |
Volume | 4 |
Issue number | 5 |
DOIs | |
State | Published - May 2022 |
Externally published | Yes |
Bibliographical note
Funding Information:Abhinav Tella, MBBS, William Vang, BS, Eustacia Ikeri, BS, Olivia Taylor, BA, Alicia Zhang, BS, Megan Mazanec, BS, Srihari Raju, MD, and Areef Ishani, MD, MS. Research idea and study design: AI; data acquisition: EI, AT, OT, AZ, MM, WV, SR; data analysis/interpretation: EI, AT, OT, AZ, MM, WV, SR; statistical analysis: EI, AT, OT, AZ, MM, WV, SR; supervision or mentorship; AI, SR. Each author contributed important intellectual content during manuscript drafting or revision and accepted accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. None. The authors declare that they have no relevant financial interests. Received September 23, 2021. Evaluated by 3 external peer reviewers, with direct editorial input from the Editor-in-Chief. Accepted in revised form February 14, 2022.
Publisher Copyright:
© 2022
Keywords
- Acebutolol
- adrenergic beta-antagonists
- atenolol
- beta blockers
- bisoprolol
- carvedilol
- hemodialysis
- labetalol
- metoprolol
- propranolol
- renal dialysis
- β-blockers
PubMed: MeSH publication types
- Journal Article