Beta-blockers had no impact on CKD mortality



SAN DIEGO – Beta-blocker use by patients with advanced chronic kidney disease was not associated with a lower risk of all-cause mortality or initiation of chronic dialysis, results from a large study demonstrated.

"The sympathetic nervous system is increased in chronic kidney disease and end-stage renal disease," Dr. Anna Jovanovich said in an interview during a poster session at Kidney Week 2012. "That can be associated with mortality – you can have more arrhythmias when your sympathetic drive is higher. You would think that beta-blockers might help decrease the sympathetic drive and then decrease mortality, but from this observational study we don’t see that association."

Dr. Anna Jovanovich

Dr. Jovanovich, a second-year renal fellow at the University of Colorado, Denver, and her associates evaluated 1,099 advanced kidney disease patients not yet on dialysis who participated in the Homocysteine in Kidney and End-Stage Renal Disease (HOST) study, conducted between 2001 and 2006.

The mean age of patients was 69 years, 98% were male, 26% were African American, and the mean estimated glomerular filtration rate was 18 mL/min per 1.73 m2. During a mean follow-up of 3 years, 453 patients (41%) died from any cause and 615 (56%) started chronic dialysis.

After adjustment for age, gender, race, smoking status, diabetes, hypertension, cardiovascular disease, body mass index, systolic blood pressure, albumin, and eGFR, baseline beta-blocker use was not associated with lower risk of all-cause mortality (adjusted HR of 1.14; P = .07), nor was it associated with a lower risk of initiation of chronic dialysis (adjusted HR of 0.90).

"This is only an observational study so we can’t draw conclusions, but in a kidney disease patient who has heart failure, I think beta-blockers are an important medication in their armamentarium," she said. "However, in a kidney disease patient without heart failure there may be other blood pressure–lowering medications to try first before you try a beta-blocker."

Dr. Jovanovich said that the findings support those of the Hemodialysis Study (Am. J. Kidney Dis. 2011;58:939-45).

Dr. Jovanovich said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.

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