Comparison of β-blocker agents and mortality in maintenance hemodialysis patients: an international cohort study.

Autor: Toye C; Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada., Sood MM; Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Mallick R; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Akbari A; Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Bieber B; Arbor Research Collaborative for Health, Ann Arbor, MI, USA., Karaboyas A; Arbor Research Collaborative for Health, Ann Arbor, MI, USA., Guedes M; Arbor Research Collaborative for Health, Ann Arbor, MI, USA., Hundemer GL; Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2024 Mar 27; Vol. 17 (5), pp. sfae087. Date of Electronic Publication: 2024 Mar 27 (Print Publication: 2024).
DOI: 10.1093/ckj/sfae087
Abstrakt: Background: Despite a lack of clinical trial data, β-blockers are widely prescribed to dialysis patients. Whether specific β-blocker agents are associated with improved long-term outcomes compared with alternative β-blocker agents in the dialysis population remains uncertain.
Methods: We analyzed data from an international cohort study of 10 125 patients on maintenance hemodialysis across 18 countries that were newly prescribed a β-blocker medication within the Dialysis Outcomes and Practice Patterns Study (DOPPS). The following β-blocker agents were compared: metoprolol, atenolol, bisoprolol and carvedilol. Multivariable Cox proportional hazards models were used to estimate the association between the newly prescribed β-blocker agent and all-cause mortality. Stratified analyses were performed on patients with and without a prior history of cardiovascular disease.
Results: The mean (standard deviation) age in the cohort was 63 (15) years and 57% of participants were male. The most commonly prescribed β-blocker agent was metoprolol (49%), followed by carvedilol (29%), atenolol (11%) and bisoprolol (11%). Compared with metoprolol, atenolol {adjusted hazard ratio (HR) 0.77 [95% confidence interval (CI) 0.65-0.90]} was associated with a lower mortality risk. There was no difference in mortality risk with bisoprolol [adjusted HR 0.99 (95% CI 0.82-1.20)] or carvedilol [adjusted HR 0.95 (95% CI 0.82-1.09)] compared with metoprolol. These results were consistent upon stratification of patients by presence or absence of a prior history of cardiovascular disease.
Conclusions: Among patients on maintenance hemodialysis who were newly prescribed β-blocker medications, atenolol was associated with the lowest mortality risk compared with alternative agents.
Competing Interests: M.M.S. received speaker fees from AstraZeneca, Otsuka, Bayer and GlaxoSmithKline, all outside of the submitted work. A.A. reported receiving speaker fees from AstraZeneca and holds research grants from Otsuka, all outside of the submitted work. A.K., M.G. and B.B. are employees of Arbor Research Collaborative for Health, which administers the DOPPS. Global support for the ongoing DOPPS Programs is provided without restriction on publications by a variety of funders. For details see https://www.dopps.org/AboutUs/Support.aspx. All funding is provided to Arbor Research and not directly to individuals. All remaining authors had no disclosures to report.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
Databáze: MEDLINE
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