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November 12, 2014
Kidney Failure Patients Should Get Beta-Blockers
Ontario, Canada—Making sure that kidney failure patients are prescribed beta-blockers that are not easily removed by dialysis can lower risk of premature death, according to a new study.
Resistant to Dialysis When the drugs used to control heart rhythm, angina, and hypertension are filtered out during dialysis, patients can’t accrue the full benefit, according to a report in the Journal of the American Society of Nephrology. The study linked initiation with a highly dialyzable beta-blocker with a 1.4 increased risk of dying within 180 days. Because beta-blockers differ in their dialyzability, researchers from Western University in Ontario analyzed health information from Canadian patients who had been prescribed beta-blockers easily removed by dialysis compared with beta-blockers that are not. In the study, the high-dialyzability group included 3,294 patients initiating dialysis while taking atenolol, acebutolol, or metoprolol. The low-dialyzability group, meanwhile, included 3,294 patients initiating dialysis while on bisoprolol or propranolol. Results indicated that dialysis patients initiating high- versus low-dialyzability beta-blockers had a 1.4-increased risk of dying within 180 days. Because an additional analysis of more than 27,000 patients who were not receiving dialysis revealed no difference in rates of premature death between the two groups, dialysis appeared to play a critical role in the process. Study authors said their findings “should raise awareness of this potentially important drug characteristic and prompt further study.” “Although we can't draw causal relationships from our observational study, we did see the relationship that we hypothesized: the risk of death was higher in patients whose beta blocker was readily removed from their circulation by hemodialysis,” said lead author Matthew Weir MD, FRCPC, MSc. “Changing prescriptions from an easily-removed drug to a difficult-to-remove drug might be a simple way to lower the risk of premature death for people receiving hemodialysis.” In an accompanying editorial, Gautam Shroff, MD, and Charles Herzog, MD, of the Hennepin County Medical Center and University of Minnesota, both in Minneapolis, questioned how much of a role dialyzability should play in beta-blocker selection. They suggested, however, that the study’s findings should encourage more research in the area. “We firmly believe sufficient impetus is now present within the academic community for creation of a well-designed randomized controlled trial to compare specific beta blockers and their effects on all-cause mortality among dialysis patients, with sudden cardiac death as a pre-specified adjudicated end point,” Shroff and Herzog write. |
U.S. Pharmacist Social Connect
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