beta-Blocker use in long-term dialysis patients: association with hospitalized heart failure and mortality.
BACKGROUND
beta-Blockers have been shown to be beneficial in the treatment and prevention of heart failure (HF) in the general population, but they have not been assessed for their association with nonfatal HF in a nationally representative population of long-term dialysis patients.


METHODS
We conducted a retrospective cohort study of 2550 patients enrolled in the US Renal Data System (USRDS) Wave 2 who were Medicare eligible at the start of the study. Analysis was stratified by the presence or absence of a known diagnosis of HF, and patients followed up until December 31, 2000. Cox regression analysis, including propensity scores, was used to model adjusted hazard ratios for beta-blocker use (assessed separately by cardioselective activity and lipid solubility) with time to the first Medicare institutional claim for HF, cardiovascular-related death, or death from any cause.


RESULTS
In patients without a previous history of HF, beta-blocker use was significantly associated with a lower adjusted risk of HF (adjusted hazard ratio, 0.69; 95% confidence interval, 0.52-0.91; P=.008), with a similar reduction in risk of cardiac-related and all-cause death. beta-Blocker use had no statistically significant associations with outcomes in patients with previous HF.


CONCLUSIONS
In dialysis patients without a previous documented history of HF, beta-blocker use was associated with a lower risk of new HF, cardiovascular death, and death from any cause. No such associations were seen for dialysis patients with a previous history of HF. These results are hypothesis generating only and should be confirmed in randomized trials.
Abbott
Kevin C
KC
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. kevin.abbott@na.amedd.army.mil
Trespalacios
Fernando C
FC
Agodoa
Lawrence Y
LY
Taylor
Allen J
AJ
Bakris
George L
GL
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists