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Abstract: PO1107

β-Blocker Dialyzability and Adverse Cardiovascular Outcomes in Hemodialysis Patients: A Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Tella, Abhinav, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Vang, William Vaajyimleej, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Ikeri, Eustacia Chiamaka, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Taylor, Olivia, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Zhang, Alicia, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Raju, Srihari I., Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Ishani, Areef, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
Background

β-blockers (BB) are one of the most common medications among hemodialysis (HD) patients. There are several BB with different pharmacokinetic properties. Particularly relevant for HD patients is BB dialyzability. In non-dialysis patients, abrupt withdrawal of BB has been associated with adverse cardiovascular events (CVE). HD patients receiving dialyzable BB may also be at increased risk for CVE. This systematic review aims to determine in HD patients if highly dialyzable BB (HDBB) (metoprolol, atenolol, and acebutolol) compared to poorly dialyzable BB (PDBB) (carvedilol, labetalol, bisoprolol, and propranolol) alters CVE and mortality.

Methods

We searched MEDLINE from 1990 through February 2020 for studies of all forms. All cause mortality (ACM) and CVE were our primary outcomes. Random effects models were used to calculate pooled risk ratios (RR).

Results

An initial search identified 1,066 articles. Exclusion criteria eliminated articles that did not include HD participants or did not compare at least two BB. Ultimately, three cohort studies comparing HDBB and PDBB were identified. All studies were retrospective cohort studies of large HD datasets of patients in the U.S. and Canada. The combined population size of the analyzed studies was 38,580 patients: 24,596 on HDBB and 13,984 on PDBB. There was significant heterogeneity between studies, with two suggesting harm associated with HDBB and one suggesting a reduction in mortality. The risk ratio derived from pooled data across these studies was 1.03 (95% CL: 0.88-1.22) for ACM and 0.94 (95% CL: 0.80-1.11) for CVE. Significant heterogeneity was seen with I^2 values of 86% and 84% for ACM and CVE respectively.

Conclusion

After a comprehensive search, only three cohort studies were identified comparing BB of different dialyzabilities. No randomized control trials were identified. The three cohort studies had varying results with two favoring HDBB and one favoring PDBB. Pooled results suggested a greater incidence of CVE in patients on PDBB compared to those on HDBB, while ACM is lower for PDBB than for HDBB. Given the heterogeneity of results it is unclear what type of BB should be used in HD patients. A randomized controlled trial comparing BB of different dialyzabilities is warranted.

Funding

  • Veterans Affairs Support