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Abstract: TH-PO422

Beta Blocker (BB) Use Patterns at ESRD Transition and Mortality Outcomes Among Congestive Heart Failure (CHF) Patients Starting Hemodialysis (HD)

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Sim, John J., Kaiser Permanente Los Angeles Medical Center, Pasadena, California, United States
  • Zhou, Hui, Kaiser Permanente Southern California, Pasadena, California, United States
  • Shi, Jiaxiao, Kaiser Permanente Southern California, Pasadena, California, United States
  • Shaw, Sally F., Kaiser Permanente Southern California, Pasadena, California, United States
  • Lee, Ming-Sum, Kaiser Permanente Los Angeles Medical Center, Pasadena, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Jacobsen, Steven J., Kaiser Permanente Southern California, Pasadena, California, United States
Background

While BB have demonstrated benefit in CHF, there is uncertainty among HD pts. Comparative BB outcomes (beta selective, dialyzability, lipophilic) in the ESRD transition period are lacking; while studies on newly initiated BB after ESRD are conflicting and overall sparse. Among CHF patients on BB at ESRD transition, we evaluated BB use patterns and 1-year mortality.

Methods

A retrospective cohort study (1/1/2007-6/30/2016) within Kaiser Permanente Southern California (an integrated health system) of CKD patients with CHF who transitioned to HD while on BB. BB use and type [dialyzable (D) vs non dialyzable (ND)] were evaluated. Multivariable regressions were used to estimate 1-year mortality HR based on post ESRD transition BB use and type.

Results

A total of 2756 pts w CHF on BB transitioned to HD (age 68 yrs, 57% males, 31% whites, 23% blacks, and 34% Hispanics). Within 120 days post transition, 25% of pts discontinued BB, 38% were on D BB, and 24% were on ND BB. Post ESRD transition, 6.5% switched their BB dialyzable types (similar both directions). Mean blood pressure w/in 120days post transition was 130/65mmHg but lowest among ND BB pts. Mortality rates were 126.5 (per 1000 person-yrs), 205.7, and 223.2 for D BB, ND BB, and pts off BB, respectively. 1-yr mortality HR’s were 1.37 (1.07-1.74) and 1.66 (1.32-2.09) for ND BB and off BB compared to D BB pts. Carvedilol (ND) pts had a mortality HR of 1.32 (1.00-1.73) vs metoprolol (D).

Conclusion

Among CHF pts on BB who transitioned to HD, 25% discontinued BB while 6.5% switched BB dialyzability types. The highest short-term mortality were observed in pts off BB followed by ND BB compared to D BB. Given the vulnerable state of ESRD transition and the high-risk CHF ESRD population, BB use may be an area of focus to help improve ESRD transition outcomes.

All-cause mortality
 Death/1,000 person-yearsCrude HR (95% CI)Adjusted HR (95% CI)*
HD-dialyzable BB126.5ReferenceReference
Non-dialyzable BB205.71.62 (1.28-2.05)1.37 (1.07-1.74)
BB discontinued223.21.76 (1.40-2.21)1.66 (1.32-2.09)

* Adjusted for age, sex, race, Afib, mean SBP<110 w/in 120days post ESRD , CCI, & cause of ESRD ^HD-dialyzable BB: atenolol, metoprolol, nadolol, sotalol; HD-nondialyzable BB: bisoprolol, carvedilol, labetalol, propranolol.

Funding

  • NIDDK Support