Tangri N, Shastri S, Tighiouart H, Beck GJ, Cheung AK, Eknoyan G, Sarnak MJ. β-Blockers for prevention of sudden cardiac death in patients on hemodialysis: a propensity score analysis of the HEMO Study.
Am J Kidney Dis 2011;
58:939-45. [PMID:
21872979 DOI:
10.1053/j.ajkd.2011.06.024]
[Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 06/15/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND
Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure.
STUDY DESIGN
Post hoc analysis of the Hemodialysis (HEMO) Study.
SETTING & PARTICIPANTS
Participants enrolled in the HEMO Study from May 1995 to February 2001.
INTERVENTION
β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts.
OUTCOMES
Sudden cardiac death adjudicated by a committee as a secondary outcome of interest.
MEASUREMENTS
We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death.
RESULTS
1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80).
LIMITATIONS
Observational nature of the study.
CONCLUSIONS
In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.
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