Comparison of ß-blocker agents and mortality in maintenance hemodialysis patients: an international cohort study.

ABSTRACT

Background: Despite a lack of clinical trial data, ß-blockers are widely prescribed to dialysis patients. Whether specific ß-blocker agents are associated with improved long-term outcomes compared with alternative ß-blocker agents in the dialysis population remains uncertain. Methods: We analyzed data from an international cohort study of 10 125 patients on maintenance hemodialysis across 18 countries that were newly prescribed a ß-blocker medication within the Dialysis Outcomes and Practice Patterns Study (DOPPS). The following ß-blocker agents were compared metoprolol, atenolol, bisoprolol and carvedilol. Multivariable Cox proportional hazards models were used to estimate the association between the newly prescribed ß-blocker agent and all-cause mortality. Stratified analyses were performed on patients with and without a prior history of cardiovascular disease. Results: The mean (standard deviation) age in the cohort was 63 (15) years and 57% of participants were male. The most commonly prescribed ß-blocker agent was metoprolol (49%), followed by carvedilol (29%), atenolol (11%) and bisoprolol (11%). Compared with metoprolol, atenolol {adjusted hazard ratio (HR) 0.77 [95% confidence interval (CI) 0.65-0.90]} was associated with a lower mortality risk. There was no difference in mortality risk with bisoprolol [adjusted HR 0.99 (95% CI 0.82-1.20)] or carvedilol [adjusted HR 0.95 (95% CI 0.82-1.09)] compared with metoprolol. These results were consistent upon stratification of patients by presence or absence of a prior history of cardiovascular disease. Conclusions: Among patients on maintenance hemodialysis who were newly prescribed ß-blocker medications, atenolol was associated with the lowest mortality risk compared with alternative agents.