α-Blocker Use in Hemodialysis: The Japan Dialysis Outcomes and Practice Patterns Study

Ken Iseri; Chisato Miyakoshi; Nobuhiko Joki; Yoshihiro Onishi; Shingo Fukuma; Hirokazu Honda; Kazuhiko Tsuruya

doi:10.1016/j.xkme.2023.100698

α-Blocker Use in Hemodialysis: The Japan Dialysis Outcomes and Practice Patterns Study

Kidney Med. 2023 Jul 4;5(9):100698. doi: 10.1016/j.xkme.2023.100698. eCollection 2023 Sep.

Authors

Ken Iseri¹, Chisato Miyakoshi², Nobuhiko Joki³, Yoshihiro Onishi⁴, Shingo Fukuma⁵, Hirokazu Honda¹, Kazuhiko Tsuruya⁶

Affiliations

¹ Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
² Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Hyogo, Japan.
³ Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
⁴ Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
⁵ Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Nephrology, Nara Medical University, Nara, Japan.

Abstract

Rationale & objective: Despite α-blockers' use for hypertension as add-on therapy in patients treated with hemodialysis, scant information is available on their association, particularly with safety, in these patients.

Study design: Prospective cohort study.

Setting & participants: patients treated with hemodialysis and receiving antihypertensive agents in the Japan Dialysis Outcomes and Practice Patterns Study, phases 4-6, were analyzed.

Exposure: Primary exposure was the prescription of α-blocking antihypertensive agents at baseline.

Outcomes: Incident fractures, falls, and all-cause mortality.

Analytical approach: Multivariable Cox and modified Poisson regression analysis.

Results: Of 5,149 patients treated with hemodialysis (mean age, 65 years; 68% men) receiving antihypertensive drugs, 717 (14%) received α-blocking agents. During a mean follow-up period of 2.0 years, 247 fractures, 525 falls, and 498 deaths occurred. Multivariable analysis showed no significant association of α-blocker use and increased risk of fractures (hazard ratio [HR], 0.92 [95% confidence interval {CI}, 0.61-1.38]), falls (HR, 0.94 [95% CI, 0.74-1.20]), or all-cause deaths (HR, 0.87 [95% CI, 0.64-1.20]) compared with α-blocker nonuse. α-Blocker use was, however, significantly associated with a decreased risk of all-cause mortality in the subgroup analysis, for example, patients who were older (HR, 0.71 [95% CI, 0.51-0.99]), were women (HR, 0.68 [95% CI, 0.48-0.95]), or reported a history of cardiovascular disease (HR, 0.67 [95% CI, 0.48-0.95]) or a predialysis blood pressure of ≥140 mm Hg (HR, 0.69 [95% CI, 0.49-0.98]).

Limitations: Selection bias cannot be ruled out given the prevalent user analysis.

Conclusions: No significant association between α-blocker use and the risk of worse safety-related outcomes was seen, indicating that clinicians may safely prescribe α-blockers to patients receiving hemodialysis who require blood pressure lowering.

Plain-language summary: α-Blockers have been generally reserved for use as add-on therapy for resistant or refractory hypertension. However, little is known about the safety of α-blockers in patients treated by hemodialysis. We analyzed 5,149 patients receiving hemodialysis in Japan who were receiving antihypertensive drugs from the Japan Dialysis Outcomes and Practice Patterns Study. The results showed no significant increase in the risk of fractures, falls, or deaths for patients using α-blockers compared with those who did not, suggesting that α-blockers may be safely prescribed for patients receiving hemodialysis who need to lower their blood pressure.

Keywords: dialysis; fall; fracture; hypertension; α-blocker.