β-Blocker Use and Risk of Mortality in Heart Failure Patients Initiating Maintenance Dialysis

Abstract

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.

Keywords: atenolol; carvedilol; chronic kidney disease (CKD); dialysis initiation; dialyzability; ejection fraction (EF); end-stage renal disease (ESRD); heart failure (HF); hospitalization; metoprolol; mortality; survival; β-blocker.