Key result
Beta-blocker therapy in dialysis patients was associated with reduced all-cause mortality in RCTs (RR 0.73; 95% CI 0.54-0.97) and observational studies (HR 0.86; 95% CI 0.80-0.92).
Why the study?
The cardiovascular protective effects of beta-blockers beyond antihypertension remain uncertain in adult patients treated with dialysis.
Does beta-blocker therapy reduce mortality and cardiovascular events in adult patients treated with dialysis?
Meta-Analysis
Does beta-blocker therapy reduce mortality and cardiovascular events in adult patients treated with dialysis?
Effect estimate: RR 0.73 (95% CI 0.54-0.97)
Beta-blocker therapy appears to be associated with reduced all-cause mortality in dialysis patients, though evidence is limited by small RCTs and heterogeneous observational data.
May support beta-blocker use to reduce mortality in dialysis; extends meta-analytic evidence but limited by small RCTs.
BACKGROUND: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. METHODS: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. RESULTS: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54-0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29-0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31-0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48-0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80-0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57-1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50-1.26). CONCLUSIONS: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club "Cappuccino with Claudio Ronco" at https://www.karger.com/Journal/ArticleNews/496083?sponsor=52.
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Jin et al. (2019) conducted a meta-analysis in Dialysis. Beta-blockers vs. No beta-blockers therapy was evaluated on All-cause mortality (RCTs) (RR 0.73, 95% CI 0.54-0.97). Beta-blocker therapy in dialysis patients was associated with reduced all-cause mortality in RCTs (RR 0.73; 95% CI 0.54-0.97) and observational studies (HR 0.86; 95% CI 0.80-0.92).
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