Why the study?
Beta-blockers are frequently prescribed in hemodialysis patients despite weak evidence, and their effects on vascular refilling—particularly whether noncardioselective, poorly dialyzable carvedilol has greater impact—remained unclear.
Does beta-blocker administration before hemodialysis impair vascular refilling and increase intradialytic hypotension in maintenance hemodialysis patients?
Does beta-blocker administration before hemodialysis impair vascular refilling and increase intradialytic hypotension in maintenance hemodialysis patients?
Administering beta-blockers, particularly noncardioselective ones like carvedilol, before hemodialysis impairs vascular refilling and increases the risk of intradialytic hypotension.
Answers are grounded in this paper and cite their sources.
Beta-blocker use before hemodialysis was associated with impaired refilling and higher intradialytic hypotension risk; leaves open optimal timing in prospective trials.
Background: β-Blockers are the most frequently prescribed cardioprotective drugs in hemodialysis (HD) patients, despite their weak evidence. We sought to evaluate the effects of β-blockers on vascular refilling during HD treatments and examine whether carvedilol, for being noncardioselective and poorly dialyzable, associates more impact than others. Methods: The study was performed in a cohort of maintenance HD patients from a tertiary center. All patients had previous β-blocker prescription. We conducted a prospective crossover study and measured vascular refilling volume (Vref) and vascular refilling fraction (Fref) in 2 circumstances: under β-blocker treatment (βb profile) and without β-blocker effect (non-βb profile). Results: Twenty patients were included, 10 of whom were treated with carvedilol. Predialysis values were comparable between the 2 profiles. Although the βb profile showed lower Vref and higher ABV drop, these differences did not reach statistical significance. Data showed an increase in Fref in the non-βb profile (70.01 ± 6.80% vs. 63.14 ± 11.65%; p = 0.015). The βb profile associated a significantly higher risk of intradialytic hypotension (IDH) (risk ratio 2.40; 95% CI: 1.04–5.55). When analyzing separately the carvedilol group, patients dialyzed under drug effect experienced a significant impairment in Vref, Fref, and refilling rate. Conclusions: Administering β-blockers before HD associated a higher risk of IDH and a decrease in Fref. Patients dialyzed under carvedilol effect showed an impaired refilling, probably related to its noncardioselectivity and lower dializability.
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Nadal et al. (2021) studied this question.
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