β-Blocker Prescription and Outcomes in Hemodialysis Patients from The Japan Dialysis Outcomes and Practice Patterns Study

Nakao, Kazushi; Makino, Hírofumi; Morita, Satoshi; Takahashi, Yoshimitsu; Akizawa, Tadao; Saitō, Akira; Asano, Yoshihide; Kurokawa, Kiyoshi; Fukuhara, Shunichi; Akiba, Takashi

doi:10.1159/000232593

Cited by 22 publications

(8 citation statements)

References 54 publications

(38 reference statements)

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“…Perhaps technological advancements such as the use of ultrapure dialysis [17][18][19] might conceivably result in gains in prevalent patient survival. Additionally, the Japanese research community should continue to investigate whether increasing the use of β-adrenergic blockers, which may benefit some patients [20,21] and which are used in comparatively lower amounts in Japan than in some other countries [22], could provide longevity benefits, especially in patients with heart failure or left ventricular hypertrophy.…”

Section: Health Trends In Esrdmentioning

confidence: 99%

Global challenges posed by the growth of end-stage renal disease

Wetmore

Collins

2016

Ren Replace Ther

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Profound challenges confront societies worldwide due to the growth of end-stage renal disease (ESRD). Meeting these challenges requires a sober assessment of how overall global health trends affect ESRD, coupled with an understanding of how progress in the care of ESRD patients is most appropriately measured and monitored. For many affluent countries, incident ESRD rates have stabilized since about the middle of the last decade. For example, the number of new cases in the USA has remained stable at approximately 110,000 per year during this period, while in Japan, growth in annual incident counts appears to have stabilized as of 2012. However, incidence rates rose for many developing countries. An immense "renal replacement therapy (RRT) gap," the difference between the number of people receiving RRT and the number needing it, was recently described, highlighting the magnitude of the difficulties these countries face as they continue to develop. To guide efforts to improve care, broad goals should be established by the worldwide renal health care community. For countries without universal dialysis access, expansion of RRT accessibility should be the first target in order to reduce the RRT gap; for countries that have moved beyond this stage, the goals should include reductions in ESRD incidence rates; all-cause, cardiovascular, and infection-related death rates; and cardiovascular-and infection-related hospitalizations. To inform judgements about progress in this area, measures beyond the traditional standardized mortality ratio are needed. Carefully determining trends over time within a given country, such as is done by the World Health Organization, might prove to be a more useful way to determine progress in combating ESRD and its complications.

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Section: Health Trends In Esrdmentioning

confidence: 99%

Global challenges posed by the growth of end-stage renal disease

Wetmore

Collins

2016

Ren Replace Ther

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“…However, the findings from such an analysis would have been strongly influenced by indication bias and the overall interpretation of our results (to choose low-instead of high-dialyzability b-blockers) would not have been altered. Furthermore, observational data have shown associations between b-blocker use and decreased mortality in patients receiving dialysis, [22][23][24] although this is not the case in patients with CKD not requiring hemodialysis. 25 Among patients receiving hemodialysis, sudden cardiac death is a common cause of death that occurs less frequently with b-blocker use.…”

Section: Limitationsmentioning

confidence: 99%

β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis

Weir

Dixon

Fleet

et al. 2015

Journal of the American Society of Nephrology

102

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Some b-blockers are efficiently removed from the circulation by hemodialysis ("high dialyzability") whereas others are not ("low dialyzability"). This characteristic may influence the effectiveness of the b-blockers among patients receiving long-term hemodialysis. To determine whether new use of a highdialyzability b-blocker compared with a low-dialyzability b-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a highversus low-dialyzability b-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P,0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). b-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study.

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“…A retrospective cohort study analyzing the US Renal Data System (USRDS) has shown that β-blocker use was associated with a lower risk of new HF and cardiovascular mortality [38]. One prospective cohort study from Japan has also demonstrated that the use of β-blockers is significantly associated with reduced risk of mortality in HD patients [39]. Among β-blockers, there are many differences in pharmacological characteristics.…”

Section: Treatment By Anti-hypertensive Drugs For Hd Patientsmentioning

confidence: 99%

Management of hypertension for patients undergoing dialysis therapy

Taniyama

2016

Ren Replace Ther

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Hypertension is very prevalent among patients undergoing dialysis therapy: hemodialysis (HD) and peritoneal dialysis (PD). Although it is recognized as a great risk of cardiovascular mortality for these populations, how to regulate blood pressure (BP) is poorly understood. For HD patients, we should pay much attention to methods of measuring BP. Outof-center BP levels and BP variability should be evaluated by ambulatory BP monitoring and home BP measurement because they are closely associated with cardiovascular mortality. Although target BP levels are not clear, several clinical guidelines suggest <140/90 mmHg. However, it must be determined for each individual patient with careful considerations about comorbidities. Based on the underling pathophysiology of hypertension in patients on dialysis, maintaining an appropriate volume of body fluid by dietary salt restriction and optimization of dry weigh should be considered as a first line therapy. Inhibitors for renin-angiotensin system may be suitable to reduce BP and mortality for those patients on dialysis. These drugs may also be effective for preserving residual renal function and peritoneal function for PD patients. β-blockers may have potentials to improve survival for HD patients and can be added to antihypertensive medications. Lacking large-scale and good quality clinical trials, there are many questions to be answered. Much effort should continuously be made to create evidences for better management of hypertension for patients on dialysis therapy.

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β-Blocker Prescription and Outcomes in Hemodialysis Patients from The Japan Dialysis Outcomes and Practice Patterns Study

Cited by 22 publications

References 54 publications

Global challenges posed by the growth of end-stage renal disease

Global challenges posed by the growth of end-stage renal disease

β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis

Management of hypertension for patients undergoing dialysis therapy

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