β-Blocker Use and Cardiovascular Outcomes in Hemodialysis: A Systematic Review

Abhinav Tella; William Vang; Eustacia Ikeri; Olivia Taylor; Alicia Zhang; Megan Mazanec; Srihari Raju; Areef Ishani

doi:10.1016/j.xkme.2022.100460

β-Blocker Use and Cardiovascular Outcomes in Hemodialysis: A Systematic Review

Kidney Med. 2022 Apr 1;4(5):100460. doi: 10.1016/j.xkme.2022.100460. eCollection 2022 May.

Authors

Abhinav Tella¹, William Vang¹, Eustacia Ikeri¹, Olivia Taylor¹, Alicia Zhang¹, Megan Mazanec¹, Srihari Raju¹, Areef Ishani¹

Affiliation

¹ Department of Veterans Affairs, Minneapolis Veterans Health Care System, Minneapolis, MN.

Abstract

Rationale & objective: There is conflicting evidence regarding the type of β-blockers to use in dialysis patients. This systematic review seeks to determine whether highly dialyzable β-blockers are associated with higher rates of cardiovascular events and mortality in hemodialysis patients than poorly dialyzable β-blockers.

Study design: A systematic review of the existing literature was conducted. A meta-analysis was performed using data from the selected studies.

Setting & study populations: Participants were from the United States, Canada, and Taiwan. The mean ages of participants ranged from 55.9-75.7 years.

Selection criteria for studies: We searched the Ovid MEDLINE database from 1990 to September 2020. Studies without adult hemodialysis participants and without comparisons of at least 2 β-blockers of different dialyzability were excluded.

Data extraction: Baseline and adjusted outcome data were extracted from each study.

Analytical approach: Random-effects models were used to calculate pooled risk ratios using fully adjusted models from individual studies.

Results: Four cohort studies were included. Pooling fully adjusted models, highly dialyzable β-blockers did not influence mortality (HR, 0.94; 95% CI, 0.81-1.08; I² = 0.84) compared with poorly dialyzable β-blockers but were associated with a reduction in cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93). There was significant heterogeneity between studies (I² = 0.35). Only 1 study reported on adverse events. Intradialytic hypotension was more common in those on carvedilol (a poorly dialyzable β-blocker) compared with those on metoprolol (a highly dialyzable β-blocker; adjusted incidence rate ratio, 1.10; 95% CI, 1.09-1.11).

Limitations: No randomized controlled trials were identified. Each study used different analytic methods and different definitions for outcomes. Classifications of β-blockers varied. Only 1 study reported on adverse events.

Conclusions: Pooled data suggest highly dialyzable β-blockers are associated with similar mortality events and fewer cardiovascular events compared with poorly dialyzable β-blockers.

Keywords: Acebutolol; adrenergic beta-antagonists; atenolol; beta blockers; bisoprolol; carvedilol; hemodialysis; labetalol; metoprolol; propranolol; renal dialysis; β-blockers.