β-Blockers for prevention of sudden cardiac death in patients on hemodialysis: a propensity score analysis of the HEMO Study

Am J Kidney Dis. 2011 Dec;58(6):939-45. doi: 10.1053/j.ajkd.2011.06.024. Epub 2011 Aug 27.

Abstract

Background: Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure.

Study design: Post hoc analysis of the Hemodialysis (HEMO) Study.

Setting & participants: Participants enrolled in the HEMO Study from May 1995 to February 2001.

Intervention: β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts.

Outcomes: Sudden cardiac death adjudicated by a committee as a secondary outcome of interest.

Measurements: We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death.

Results: 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80).

Limitations: Observational nature of the study.

Conclusions: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Comorbidity
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / prevention & control*
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Propensity Score
  • Proportional Hazards Models
  • Renal Dialysis*
  • Risk Factors
  • Survival Analysis

Substances

  • Adrenergic beta-Antagonists