β-Blocker Use and Risk of Mortality in Heart Failure Patients Initiating Maintenance Dialysis
Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved..
RATIONAL & OBJECTIVE: Beta-blockers are recommended for patients with heart failure (HF) but their benefit in the dialysis population is uncertain. Beta-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 patients with chronic kidney disease with HF who transitioned to dialysis.
STUDY DESIGN: Retrospective cohort study.
SETTING & PARTICIPANTS: Adults patients with chronic kidney disease (aged≥18 years) and HF who initiated either hemodialysis or peritoneal dialysis during January 1, 2007, to June 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.
ANALYTICAL APPROACH: Inverse probability of treatment weights using 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: 3,503 patients were included in the study. There were 2,115 (60.4%) patients using β-blockers at transition. Compared with nonusers, the HR 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.
CONCLUSIONS: Beta-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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:77 |
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| Enthalten in: |
American journal of kidney diseases : the official journal of the National Kidney Foundation - 77(2021), 5 vom: 15. Mai, Seite 704-712 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhou, Hui [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.05.2021 Date Revised 10.05.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1053/j.ajkd.2020.07.023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315806559 |
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| 500 | |a Date Revised 10.05.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a RATIONAL & OBJECTIVE: Beta-blockers are recommended for patients with heart failure (HF) but their benefit in the dialysis population is uncertain. Beta-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 patients with chronic kidney disease with HF who transitioned to dialysis | ||
| 520 | |a STUDY DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING & PARTICIPANTS: Adults patients with chronic kidney disease (aged≥18 years) and HF who initiated either hemodialysis or peritoneal dialysis during January 1, 2007, to June 30, 2016, within an integrated health system were included | ||
| 520 | |a EXPOSURES: Patients were considered treated with β-blockers if they had a quantity of drug dispensed covering the dialysis transition date | ||
| 520 | |a OUTCOMES: All-cause mortality within 6 months and 1 year or hospitalization within 6 months after transition to maintenance dialysis | ||
| 520 | |a ANALYTICAL APPROACH: Inverse probability of treatment weights using 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 | ||
| 520 | |a RESULTS: 3,503 patients were included in the study. There were 2,115 (60.4%) patients using β-blockers at transition. Compared with nonusers, the HR 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 | ||
| 520 | |a LIMITATIONS: The observational nature of our study could not fully account for residual confounding | ||
| 520 | |a CONCLUSIONS: Beta-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 | ||
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