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Haddiya I, Valoti S. Current Knowledge of Beta-Blockers in Chronic Hemodialysis Patients. Int J Nephrol Renovasc Dis 2023; 16:223-230. [PMID: 37849744 PMCID: PMC10578177 DOI: 10.2147/ijnrd.s414774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Beta-blockers include a large spectrum of drugs with various specific characteristics, and a well-known cardioprotective efficacy. They are recommended in heart failure, hypertension and arrhythmia. Their use in chronic hemodialysis patients is still controversial, mainly because of the lack of specific randomized clinical trials. Large observational studies and two important clinical trials have reported almost unanimously their efficacy in chronic hemodialysis patients, which seems to be related to their levels of dialyzability and cardioselectivity. A recent meta-analysis suggested that high dialyzable beta-blockers are correlated to a reduced risk of all-cause mortality and cardiovascular complications compared with low dialyzable beta-blockers. Despite their benefits, beta-blockers may have adverse effects, such as intradialytic hypotension with low dialyzability beta-blockers or the risk of sub-therapeutic plasma concentration of high dialyzable ones during dialysis sessions. Both cases are linked to adverse cardiovascular events. A solution for both high and low dialyzable drugs could be their administration after dialysis sessions. Futhermore, the bulk of existing literature seems to favor cardioselective beta-blockers with moderate-to-high dialyzability as the ideal agents in dialysis patients, but further, larger studies are needed. This review aims to analyze beta-blockers' characteristics, indications and evidence-based role in chronic hemodialysis patients.
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Affiliation(s)
- Intissar Haddiya
- Department of Nephrology, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco
| | - Siria Valoti
- Department of Medicine, Faculty of Medicine, Università degli Studi di Milano Statale, Milano, Italia
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Aoun M, Tabbah R. Beta-blockers use from the general to the hemodialysis population. Nephrol Ther 2019; 15:71-76. [PMID: 30718084 DOI: 10.1016/j.nephro.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/01/2018] [Indexed: 01/02/2023]
Abstract
Beta-blockers have numerous indications in the general population and are strongly recommended in heart failure, post-myocardial infarction and arrhythmias. In hemodialysis patients, their use is based on weak evidence because of the lack of a sufficient number of randomized clinical trials. The strongest evidence is based on two trials. The first showed better survival with carvedilol in hemodialysis patients with four sessions per week and systolic heart failure. The second found reduced cardiovascular morbidity with atenolol compared to lisinopril in mostly black hypertensive hemodialysis patients. No clinical trials exist regarding myocardial infarction. Large retrospective studies have assessed the benefits of beta-blockers in hemodialysis. A large cohort of hemodialysis patients with new-onset heart failure showed better survival when treated with carvedilol, bisoprolol or metoprolol. Another recent one of 20,064 patients found out that metoprolol compared to carvedilol was associated with less all-cause mortality. There is still uncertainty also regarding the impact of dialysability of beta-blockers on patient's survival. On top of that, many observations suggested that beta-blockers were associated with a reduced rate of sudden cardiac death in hemodialysis patients but recent data show a link between bradycardia and sudden cardiac death questioning the benefit of beta-blockade in this population. Finally, what we know for sure so far is that beta-blockers should be avoided in patients with intradialytic hypotension associated with bradycardia.
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Affiliation(s)
- Mabel Aoun
- Department of nephrology, Saint-Georges Hospital, Saint-Joseph University, Damascus street, Beirut, Lebanon.
| | - Randa Tabbah
- Department of cardiology, Holy Spirit University, Kaslik, Lebanon
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Mlodawska E, Lopatowska P, Malyszko J, Banach M, Sobkowicz B, Covic A, Tomaszuk-Kazberuk A. Atrial fibrillation in dialysis patients: is there a place for non-vitamin K antagonist oral anticoagulants? Int Urol Nephrol 2018; 50:1633-1642. [PMID: 29785661 DOI: 10.1007/s11255-018-1877-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/18/2018] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) occurs approximately in 3% of general population, with greater prevalence in elderly. Non-vitamin K-dependent oral anticoagulant agents (NOACs) according to the current European guidelines are recommended for patients with AF at high risk for stroke as a first-choice treatment. NOACs are not inferior to warfarin or some of them are better than warfarin in reducing the rate of ischemic stroke. Moreover, they significantly reduce the rate of intracranial hemorrhages, major bleedings, and mortality compared with warfarin. Nevertheless according to ESC guidelines, NOACs are not recommended in patients with creatinine clearance < 30 mL/min. Observational studies provide contradictive data. Only few new trials are ongoing. Therefore, it is not clear if NOACs should be in the future prescribed to patients with advanced CKD and those on dialysis. Moreover, the risk of stroke and bleeding is much higher in such population than in patients without end-stage renal disease (ESRD). The authors provide data on pros and cons of use of NOACs in ESRD patients with AF.
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Affiliation(s)
- Elzbieta Mlodawska
- Department of Cardiology, Medical University in Bialystok, Białystok, Poland
| | - Paulina Lopatowska
- Department of Cardiology, Medical University in Bialystok, Białystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University in Bialystok, Białystok, Poland
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University in Bialystok, Białystok, Poland. .,Department of Cardiology, University Hospital in Bialystok, ul. Skłodowskiej-Curie 24A, 15-276, Białystok, Poland.
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Budzisz E, Nowicki M. Opinions of nephrologists on the efficacy and tolerance of statins in hemodialysis patients. Ren Fail 2017; 39:277-282. [PMID: 27885903 PMCID: PMC6014331 DOI: 10.1080/0886022x.2016.1260032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/07/2016] [Indexed: 01/13/2023] Open
Abstract
Large randomized controlled trials have not confirmed the effects of statin therapy on reduction of cardiovascular morbidity and mortality in end-stage kidney disease, despite that statins are still widely prescribed by nephrologists to chronic dialysis patients. The aim of the study was to analyze the attitudes of nephrologists towards statin use in hemodialysis patients. Self-designed questionnaire, containing 18 questions, was distributed among 115 nephrologists. The survey contained description of the results of 3 largest statin trials in nephrology. The questions referred to the interpretation of trial results and the safety and efficacy of statin therapy and dose adjustments required in dialysis patients. 83% among 72 nephrologists who returned the questionnaire prescribed statins to their dialysis patients for secondary prevention of cardiovascular events. 90% prescribed atorvastatin. 64% nephrologists did not modify statin dose at the start of hemodialysis treatment and 47% before elective surgery. Liver disease was indicated as a main reason for dose modification in hemodialysis patients. Statin-induced myopathy was observed by 65% nephrologists and 61% reported a case of increased liver enzymes. 51% of nephrologists did not routinely discuss the possible benefits and risks of statin therapy with their patients. Statins are still widely prescribed and considered safe and effective lipid-lowering therapy in dialysis patients by most nephrologists.
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Affiliation(s)
- Ewa Budzisz
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
| | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland
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Wang AYM, Brimble KS, Brunier G, Holt SG, Jha V, Johnson DW, Kang SW, Kooman JP, Lambie M, McIntyre C, Mehrotra R, Pecoits-Filho R. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part II - Management of Various Cardiovascular Complications. Perit Dial Int 2016; 35:388-96. [PMID: 26228783 DOI: 10.3747/pdi.2014.00278] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular mortality has remained high in patients on peritoneal dialysis (PD) due to the high prevalence of various cardiovascular complications including coronary artery disease, left ventricular hypertrophy and dysfunction, heart failure, arrhythmia (especially atrial fibrillation), cerebrovascular disease, and peripheral arterial disease. In addition, nearly a quarter of PD patients develop sudden cardiac death as the terminal life event. Thus, it is essential to identify effective treatment that may lower cardiovascular mortality and improve survival of PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendation statements regarding lifestyle modification, assessment and management of various cardiovascular risk factors, and management of the various cardiovascular complications to be published in 2 guideline documents. This publication forms the second part of the guideline documents and includes recommendation statements on the management of various cardiovascular complications in adult chronic PD patients. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. We also define areas where evidence is clearly deficient and make suggestions for future research in each specific area.
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Affiliation(s)
| | - K Scott Brimble
- St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Brunier
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G Holt
- Division of Nephrology, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Vivekanand Jha
- George Institute for Global Health India, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David W Johnson
- University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Yonsei University, Korea
| | - Jeroen P Kooman
- Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Mark Lambie
- Health Services Research Unit, Institute for Science and Technology in Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Chris McIntyre
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, United Kingdom
| | - Rajnish Mehrotra
- Harborview Medical Center, Division of Nephrology/Department of Medicine, University of Washington, Washington, DC, United States
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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