What question did this study set out to answer?

To examine whether beta-blocker therapy improves cardiovascular outcomes among older incident chronic dialysis patients.

August 26, 2011Nephrology Dialysis TransplantationOpen Access

Beta-blockers and cardiovascular outcomes in dialysis patients: a cohort study in Ontario, Canada

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Why the study?

Does beta-blocker therapy reduce the composite of death, myocardial infarction, stroke or coronary revascularization in older patients receiving chronic dialysis?

Population

1,836 consecutive chronic dialysis patients aged ≥66 years who initiated dialysis between 1 July 1991 and 31…

Comparison

Initiation of beta-blockers after the initiation… vs Initiation of statins only, or calcium channel…

Design

Cohort

Authors

AKAbhijat KitchluUniversity Health Network KCKristin K. ClemensWestern University TGTara GomesWomen's College Hospital

Discussion

Member takes

Implication

Beta-blocker use was not associated with improved cardiovascular outcomes versus statin-only in older dialysis patients; leaves open benefit in randomized trials.

Key Points

To examine whether beta-blocker therapy improves cardiovascular outcomes among older incident chronic dialysis patients.
Retrospective cohort study of linked healthcare databases in Ontario, Canada, analyzing consecutive chronic dialysis patients aged ≥66 years who began dialysis between July 1, 1991, and July 31, 2007 (N=1836).
Patients were categorized by newly initiated medication into beta-blockers (n=504), calcium channel blockers (n=570), or statins only (n=762).
Assessed time to a primary composite endpoint of death, myocardial infarction, stroke, or coronary revascularization.
Beta-blocker use was not associated with improved composite cardiovascular outcomes compared with statin-only use (adjusted HR 1.07, 95% CI 0.92–1.23).
Calcium channel blocker use was also not associated with reduced cardiovascular events relative to statin-only use (adjusted HR 0.91, 95% CI 0.79–1.06).
In subgroup analyses, high-dose beta-blocker therapy showed improved cardiovascular outcomes compared to low-dose beta-blockers (adjusted HR 0.50, 95% CI 0.29–0.88).

Structured PICO

Does beta-blocker therapy reduce the composite of death, myocardial infarction, stroke or coronary revascularization in older patients receiving chronic dialysis?

Population

1,836 consecutive chronic dialysis patients aged ≥66 years who initiated dialysis between 1 July 1991 and 31 July 2007

Intervention

Initiation of beta-blockers (with or without concurrent statin) after the initiation of chronic dialysis

Comparator

Initiation of statins only, or calcium channel blockers (with or without concurrent statin)

Outcome

Time to a composite endpoint of death, myocardial infarction, stroke or coronary revascularizationcomposite

Beta-blocker initiation in older patients starting chronic dialysis was not associated with improved cardiovascular outcomes compared to statin-only use, though high-dose therapy may offer benefit over low-dose.

Cite This Study

Kitchlu et al. (2011) studied this question.

synapsesocial.com/papers/6a7de8fe33dcb27c99cb6017 https://doi.org/10.1093/ndt/gfr460

Topics

Statin therapy Women and heart disease Cardiovascular prevention

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Implication

Beta-blocker use was not associated with improved cardiovascular outcomes versus statin-only in older dialysis patients; leaves open benefit in randomized trials.

Beta-blockers and cardiovascular outcomes in dialysis patients: a cohort study in Ontario, Canada

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Beta-blockers and cardiovascular outcomes in dialysis patients: a cohort study in Ontario, Canada

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider