Cardio-selective versus non-selective β-blockers for cardiovascular events and mortality in long-term dialysis patients: A systematic review and meta-analysis

Abstract

Background Trials in patients receiving dialysis have demonstrated that β-blockers reduce all-cause mortality and cardiovascular events. However, differences still exist within-class comparative effectiveness studies of the therapeutic benefits of β-blockers in dialysis patients. Objective The purpose of this systematic review is to examine whether cardiovascular events and all-cause mortality differed between dialysis patients receiving cardio-selective and non-selective agents. Methods A comprehensive search of relevant articles from the PubMed, EMBASE, Cochrane Central Register and ClinicalTrials.gov was performed up to September 4, 2022, we included adults receiving β-blockers to evaluate the effects of cardio-selective versus non-selective agents on mortality and cardiovascular events in the dialysis population. Hazard ratios (HRs) and 95% confidence intervals (CIs) were examined for the negative outcomes of cardiovascular events and death for any reason. The risk of bias in randomized controlled trials (RCTs) was assessed using Cochrane’s risk of bias tool and the risk of bias in observational studies was assessed using a table designed according to the ROBINS-I tool, the evidence grade was assessed using the GRADE guideline. For all-cause mortality and cardiovascular events, the RevMan software (version 5.3) was used to calculate pooled HRs with 95% CI. The heterogeneity (I2) in statistics was used to examine the degree of heterogeneity among studies. Results Four observational studies, including 58, 652 long-term dialysis patients, were included in the meta-analysis. Compared to dialysis patients who took non-selective β-blockers, who took cardio-selective β-blockers was probably associated with fewer cardiovascular events (hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81, 0.89, heterogeneity [I2] = 0%, three trials, 52,077 participants, moderate-quality evidence) and may have lower all-cause mortality (HR = 0.83, 95% CI = 0.69, 0.99, I2 = 91%, four trials, 54,115 participants, low-quality evidence). Conclusions This systematic review showed that cardio-selective β-blockers are probably associated with fewer cardiovascular events and may have lower all-cause mortality in long-term dialysis patients than non-selective β-blockers. The present study results need to be replicated using randomized controlled trials with longer observation durations.

Influence of Different Types of β-Blockers on Mortality in Patients on Hemodialysis

“…Some studies showed better clinical outcomes with dialyzable and/or cardioselective β-blockers than with non-dialyzable and/or non-cardioselective ones, despite overall inconsistent results between the types of β-blockers and the clinical outcomes [7][8][9][10][11][12][13][14][15][16][17][18]. However, our study did not show superiority in patient survival based on the type of β-blockers.…”

“…However, they have different characteristics based on dialyzability and/or cardioselectivity, which may result in different effects on the survival of patients with HD. Previous studies have evaluated the association between types of β-blockers and outcomes in patients with HD [7][8][9][10][11][12][13][14][15][16][17][18]. However, results regarding this association were inconsistent.…”

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path

“…A propensity-matched retrospective cohort study comparing dialysis clearance and morbidity and mortality in dialysis patients on different medications showed that in HD patients, the use of DBBs is associated with an increased risk of death in the subsequent 6 months compared with NDBBs [ 148 ]. It has been suggested [ 149 ] that the use of cardio-selective BB may be associated with fewer CV events and lower all-cause mortality compared with dialysis patients on non-selective BB. A propensity-matched retrospective cohort study [ 150 ] of 3400 HD patients with HF showed lower all-cause mortality in patients treated with BB and even lower mortality in patients treated concomitantly with BB and ACEIs or ARBs.…”

Diastolic function in chronic kidney disease

“…A reduction of heart rate might result in increased diastolic filling and improved stroke volume, which is energetically convenient. The use of β-blockers has been shown to improve outcome in ESKD [ 105 , 106 ]. Improvement of diastolic function can be achieved by managing structural, haemodynamic and biological conditions impairing mechanisms of active relaxation and passive filling.…”