Key result
Dialyzable beta-blockers linked to ~18% lower mortality and reduced MACE vs nondialyzable beta-blockers.
Why the study?
Beta-blocker dialyzability has been proposed to limit efficacy in hemodialysis patients, prompting an evaluation of outcomes with dialyzable versus nondialyzable beta-blockers.
Does the initiation of dialyzable beta-blockers reduce all-cause mortality and MACEs in hemodialysis patients compared to nondialyzable beta-blockers?
Cohort (n=36,603)
Yes
Does the initiation of dialyzable beta-blockers reduce all-cause mortality and MACEs in hemodialysis patients compared to nondialyzable beta-blockers?
Hazard Ratio: 0.82 (95% CI 0.75–0.88)
In hemodialysis patients, dialyzable beta-blockers are associated with lower mortality and cardiovascular events compared to nondialyzable beta-blockers, challenging the hypothesis that dialyzability limits their efficacy.
Should not yet change beta-blocker selection in hemodialysis; hypothesis-generating and warrants randomized confirmation.
BACKGROUND: β-blocker (BB) dialyzability has been proposed to limit their efficacy among hemodialysis (HD) patients. We attempted to confirm this hypothesis by comparing health outcomes associated with the initiation of dialyzable or nondialyzable BBs in a nationwide cohort of HD patients. METHODS: We created a prospective cohort study of 15 699 HD patients who initiated dialyzable BBs (atenolol, acebutolol, metoprolol and bisoprolol) and 20 904 hemodialysis patients who initiated nondialyzable BBs (betaxolol, carvedilol and propranolol) between 2004 and 2011 in Taiwan healthcare. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs, a composite of the acute coronary syndrome, ischemic stroke and heart failure) between users of dialyzable versus nondialyzable BBs during a 2-year follow-up. RESULTS: New users of dialyzable BBs were younger, more often men, with diabetes mellitus, hypertension and hyperlipidemia compared with users of nondialyzable BBs. Compared with nondialyzable BBs, initiation of dialyzable BBs was associated with lower all-cause mortality {hazard ratio [HR] 0.82 [95% confidence interval (CI) 0.75-0.88]} and lower risk of MACEs [HR 0.89 (95% CI 0.84-0.93)]. Results were confirmed in subgroup analyses, censoring at BB discontinuation or switch, after 1:1 propensity score matching, reclassifying bisoprolol or excluding bisoprolol/carvedilol users. CONCLUSIONS: This study does not offer support for the hypothesis that the dialyzability of BBs reduces their efficacy in HD patients.
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Wu et al. (2020) conducted a cohort in Hemodialysis patients requiring beta-blocker therapy (n=36,603). Dialyzable beta-blockers vs. Nondialyzable beta-blockers was evaluated on All-cause mortality (HR 0.82, 95% CI 0.75-0.88). Initiation of dialyzable beta-blockers was associated with lower all-cause mortality (HR 0.82; 95% CI 0.75-0.88) and MACEs (HR 0.89; 95% CI 0.84-0.93) compared with nondialyzable beta-blockers.
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