β-Blocker Use and Cardiovascular Outcomes in Hemodialysis: A Systematic Review

Should We Use Dialyzable β-Blockers in Hemodialysis?

“…When the meta-analysis was repeated excluding the study of Weir et al 8 from quantitative data synthesis, the use of a highly dialyzable β-blocker was associated with 13% reduced risk of all-cause mortality (HR, 0.87; 95% CI, 0.80-0.94) and with 13% reduced risk of adverse cardiovascular events (HR, 0.87; 95% CI, 0.84-0.91). 5 Contrary to the original hypothesis that high dialyzability would limit the therapeutic efficacy of β-blockers and would aggravate the risk of adverse events, the use of highly dialyzable β-blockers was shown to be associated with reduced cardiovascular morbidity and all-cause mortality.…”

“… 5 Unlike the accumulated concerns around the cardiovascular safety of highly dialyzable β-blockers, their use was associated with 12% lower risk of adverse cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93). 5 …”

“…In this issue of Kidney Medicine , Tella et al 5 performed a systematic review of the literature aiming to identify studies comparing the safety and efficacy of highly dialyzable and poorly dialyzable β-blockers in patients receiving hemodialysis. Of the 78 potentially relevant reports retrieved, only 4 studies met the prespecified inclusion/exclusion criteria, and, unfortunately, the literature search failed to identify any randomized controlled trial that provided a head-to-head comparison between β-blockers with different degrees of dialyzability.…”

“…Taking into consideration that all 4 eligible studies followed a retrospective observational design, it is not surprising that method quality assessment graded these studies as having an overall “high” risk of bias. 5 When risk ratios from fully adjusted Cox regression models of each individual study were inserted in quantitative data synthesis, there was no significant difference between highly dialyzable and poorly dialyzable β-blockers in all-cause death risk (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.81-1.08). 5 Unlike the accumulated concerns around the cardiovascular safety of highly dialyzable β-blockers, their use was associated with 12% lower risk of adverse cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93).…”

“…Accordingly, in their report, Tella et al 5 performed a sensitivity analysis addressing the issue of misclassification of bisoprolol as a poorly dialyzable β-blocker. When the meta-analysis was repeated excluding the study of Weir et al 8 from quantitative data synthesis, the use of a highly dialyzable β-blocker was associated with 13% reduced risk of all-cause mortality (HR, 0.87; 95% CI, 0.80-0.94) and with 13% reduced risk of adverse cardiovascular events (HR, 0.87; 95% CI, 0.84-0.91).…”