Study on β-blockers and Heart Failure

Current national guidelines recommend that clinicians treat patients with heart failure and left ventricular systolic dysfunction with β-adrenergic receptor blockers (β-blockers), based on robust evidence from several randomized clinical trials showing a reduction in mortality and morbidity. More than two-thirds of patients with heart failure also have chronic kidney disease (CKD), which independently increases the risk of adverse cardiovascular events and death.

According to a new study published in the American Journal of Kidney Diseases, β-blockers have been associated with a lower rate of mortality among incident hemodialysis patients with heart failure.

To date, β-blockers are recommended for heart failure (HF) patients but their benefit in the dialysis population is uncertain. β-blockers are heterogeneous including concerning their removal by hemodialysis.

With this in view, researchers sought to evaluate whether β-blocker use and their dialyzability characteristics were associated with early mortality among chronic kidney disease (CKD) patients with HF who transitioned to dialysis.

The research team undertook a retrospective cohort study with participants as adult patients with CKD (age ≥ 18 years) and HF who initiated either hemodialysis or peritoneal dialysis during 1/1/2007-6/30/2016 within an integrated health system.

Patients were considered treated with β-blockers if they had a quantity of drug dispensed covering the dialysis transition date.

The primary outcome that was evaluated was all-cause mortality within 6 months and 1 year, or hospitalization within 6 months after transitioning to maintenance dialysis.

Key Findings

• A total of 3,503 patients were included in the study.
• There were 2,115 (60.4%) patients on β-blockers at transition.
• Compared to non-users, the hazard ratio for all-cause mortality within 6 months was 0.79 (95% CI: 0.65-0.94) among users of any β-blocker, and 0.68 (95% CI: 0.53-0.88) among users of metoprolol at transition.
• There were no observed differences in all-cause or cardiovascular-related hospitalization.

For the full article, click on the link: https://doi.org/10.1053/j.ajkd.2020.07.023

Primary source: American Journal of Kidney Diseases