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January 1, 2002˜The œNephron journals/Nephron journals

Nonselective Beta-Adrenergic Blockade Augments Fasting Hyperkalemia in Hemodialysis Patients

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Why the study?

Does nonselective or beta1-selective beta-blockade augment fasting hyperkalemia in hemodialysis patients?

Population

12 anuric, long-term hemodialysis patients (mean dialysis duration 6.4 +/- 2.7 years)

Comparison

Single dose of nonselective beta-blocker nadolol… vs Placebo administered at the beginning of an…

Design

RCT, random order, blinded fashion

Follow-up

18 hours

Authors

MNMichał NowickiJMJoanna Miszczak-Kuban

Discussion

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Overview

Clinicians should favor beta1-selective over nonselective beta-blockers during fasting in hemodialysis; confirms selectivity-dependent hyperkalemia risk.

Key Points

  • To determine whether nonselective versus beta-1 selective adrenergic receptor blockade exacerbates fasting hyperkalemia in patients with end-stage renal disease on maintenance hemodialysis.
  • Twelve anuric, long-term hemodialysis patients underwent three separate 18-hour fasting periods with a 7-day washout interval.
  • At the onset of each fast, participants received a single oral dose of the nonselective beta-blocker nadolol (80 mg), the beta-1 selective blocker betaxolol (20 mg), or placebo in a randomized, blinded crossover fashion.
  • Fasting increased serum potassium in all groups, but the rise was significantly greater following nadolol (1.2 ± 0.4 mmol/l) than placebo (0.6 ± 0.6 mmol/l; p = 0.01).
  • The potassium increase after betaxolol (0.9 ± 0.6 mmol/l) was not significantly different compared to placebo (p = 0.30).
  • Mean blood pressure reduction (18 ± 10 vs. 19 ± 11 mm Hg) and heart rate decrease (20 ± 3 vs. 19 ± 6 bpm) were similar between nadolol and betaxolol, while insulin and glucose declined identically across all arms without changes in aldosterone.

Structured PICO

Does nonselective or beta1-selective beta-blockade augment fasting hyperkalemia in hemodialysis patients?

P
Population
12 anuric, long-term hemodialysis patients (mean dialysis duration 6.4 +/- 2.7 years)
I
Intervention
Single dose of nonselective beta-blocker nadolol (80 mg) or beta1-selective blocker betaxolol (20 mg) administered at the beginning of an 18-hour fasting period
C
Comparator
Placebo administered at the beginning of an 18-hour fasting period
O
Outcome
Increase in serum potassium during the 18-hour fasting periodsurrogate

Nonselective beta-blockers, but not beta1-selective blockers, significantly augment fasting hyperkalemia in hemodialysis patients, highlighting a potential risk during fasting periods.

Cite This Study

Nowicki et al. (2002) studied this question.

synapsesocial.com/papers/6a7de8fe33dcb27c99cb601bhttps://doi.org/10.1159/000058396
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