Am J Kidney Dis. 2020 Sep 23:S0272-6386(20)31001-5. doi: 10.1053/j.ajkd.2020.07.023. Online ahead of print.
RATIONAL & OBJECTIVE: β-blockers are recommended for heart failure (HF) patients but their benefit in the dialysis population is uncertain. β-blockers are heterogeneous including with respect to their removal by hemodialysis. We sought to evaluate whether β-blocker use and their dialyzability characteristics were associated with early mortality among chronic kidney disease (CKD) patients with HF who transitioned to dialysis.
STUDY DESIGN: Retrospective cohort study SETTING AND PARTICIPANTS: Adults patients with CKD (age ≥ 18 years) and HF who initiated either hemodialysis or peritoneal dialysis during 1/1/2007-6/30/2016 within an integrated health system were included.
EXPOSURES: Patients were considered treated with β-blockers if they had a quantity of drug dispensed covering the dialysis transition date.
OUTCOMES: All-cause mortality within 6 months and 1 year, or hospitalization within 6 months after transition to maintenance dialysis ANALYTIC APPROACH: Inverse probability of treatment weights using the propensity scores was used to balance covariates between treatment groups. Cox proportional hazard analysis and logistic regression were used to investigate the association between β-blocker use and study outcomes.
RESULTS: A total of 3,503 patients were included in the study. There were 2,115 (60.4%) patients on β-blockers at transition. Compared to non-users, the hazard ratio for all-cause mortality within 6 months was 0.79 (95% CI: 0.65-0.94) among users of any β-blocker, and 0.68 (95% CI: 0.53-0.88) among users of metoprolol at transition. There were no observed differences in all-cause or cardiovascular-related hospitalization.
LIMITATIONS: The observational nature of our study could not fully account for residual confounding.
CONCLUSION: β-blockers were associated with a lower rate of mortality among incident hemodialysis patients with HF. Similar associations were not observed for hospitalizations within the first 6 months following transition to dialysis.