Abstract: SA-PO870
Renal, Cardiac, and Safety-Related Events with Alpha Blockers in Patients with CKD
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Hundemer, Gregory L., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Petrcich, William, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Hiremath, Swapnil, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ruzicka, Marcel, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
Background
Alpha-blockers (ABs) are commonly prescribed as add-on therapy for blood pressure (BP) control in patients with and without chronic kidney disease (CKD). However, the association between AB use and renal, cardiac, mortality, and safety-related outcomes by CKD stage remains unknown.
Methods
Population-based, retrospective cohort study of Ontario (Canada) residents ≥66 years old with a diagnosis of hypertension from 2007 to 2015. Patients newly prescribed an AB (doxazosin, terazosin, prazosin) were matched to patients newly prescribed a non-AB BP-lowering medication using a high dimensional propensity score. Cox proportional hazards models examined the association of AB use with renal (≥30% eGFR decline, need for renal replacement therapy [RRT]), cardiac, mortality, and safety (hypotension, syncope, falls, fractures) outcomes compared to AB non-use by baseline eGFR categories (≥90, 60-89, 30-59, <30 mL/min/1.73m2).
Results
From 329,799 eligible patients, 18,460 were dispensed ABs and matched 1:1 to non-AB users. Among patients with CKD, AB use was associated with a higher risk of the following adverse renal outcomes compared with non-AB use: (See Figure)
≥30% eGFR Decline:
eGFR 30-59 mL/min/1.73m2: HR 1.10 [95%CI 1.02-1.18]
eGFR <30 mL/min/1.73m2: HR 1.35 [95%CI 1.19-1.54]; p-interaction <0.001
RRT:
eGFR 30-59 mL/min/1.73m2: HR 1.30 [95%CI 1.00-1.68]
eGFR <30 mL/min/1.73m2: HR 1.36 [95%CI 1.12-1.66]
There were no significant differences in cardiac, mortality, or safety-related events between AB users and non-users by CKD stage.
Conclusion
ABs are associated with a higher risk of adverse renal outcomes in patients with CKD compared with other BP-lowering medications.
Adverse Kidney Outcomes in Alpha-Blocker Users vs. Non-Users