Beta-blockers may reduce mortality rate for patients with heart, kidney failure
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For patients with both heart and kidney failure, beta-blocker use was associated with decreased mortality rates within 1 year after dialysis initiation.
According to Hui Zhou, PhD, of the department of research and evaluation at Kaiser Permanente Southern California, and colleagues, beta-blocker therapy is generally thought to be beneficial to patients with chronic kidney disease. However, they contended that less is known about its impact on patients once they progress to end-stage kidney disease and must transition to dialysis.
“ESRD patients with cardiovascular disease are usually excluded from many important clinical trials resulting in the lack of information on medication efficacy among this population overall,” the researchers wrote. “Previous observational studies have shown conflicting results on whether there are benefits with [beta]-blocker use among ESRD patients with [heart failure] HF.”
To further investigate, Zhou and colleagues examined all-cause mortality and hospitalization rates in 3,503 patients with heart failure and CKD who initiated either hemodialysis or peritoneal dialysis between 2007 and 2016 (mean age, 68 years; 42% were women; 20% had reduced ejection fraction [EF], defined as EF 40%).
Of the total study population, 60.4% were using beta-blockers at the time of dialysis initiation, with results showing patients who were on the therapy had lower mortality rates compared with those who were not on the therapy. More specifically, compared with non-users, the hazard ratio for all-cause mortality within 6 months was 0.79 for users of any beta-blocker and 0.68 for those using metoprolol. Mortality at 1 year was also lower for those taking beta-blockers (HR = 0.78).
Regarding hospitalizations, no statistically significant differences were observed between patients taking beta-blockers vs. those who were not taking beta-blockers.
“In this study of a large diverse population of CKD patients with HF who transitioned to dialysis, we observed a 21% lower 6-month mortality risk among patients with HF who were on [beta]-blockers at transition to dialysis compared to those who were not on [beta]-blockers,” Zhou and colleagues concluded. “Our findings suggest a potential benefit of the use of [beta]-blockers among HF patients who transition to dialysis.”
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