[Efficacy of additional low-dose carvedilol in maintenance hemodialysis patients with asymptomatic left ventricular systolic dysfunction].
OBJECTIVE
The effects of additional low-dose carvedilol were evaluated in maintenance hemodialysis patients with asymptomatic left ventricular systolic dysfunction for 2 years.


METHODS
Thirteen hemodialysis patients with asymptomatic left ventricular systolic dysfunction (left ventricular ejection fraction < 45%) were given carvedilol (5 mg) at every hemodialysis period. Echocardiography and brain natriuretic peptide level were measured at baseline, 3, 6, 12, and 24 months after treatment.


RESULTS
There was no major complication with 5 mg of carvedilol during 24 months. Two-year echocardiographic data revealed a significant attenuation of pathophysiologic remodeling, with smaller left ventricular end-diastolic volume (170 +/- 33 to 157 +/- 26ml, p < 0.0001) and higher left ventricular ejection fraction (38 +/- 6% to 49 +/- 5%, p < 0.0001) after 6 months. In addition, brain natriuretic peptides were significantly decreased after 6 months (378 +/- 174 to 181 +/- 122 pg/ml, p < 0.0001).


CONCLUSIONS
Additional low-dose carvedilol therapy in maintenance hemodialysis patients with asymptomatic left ventricular systolic dysfunction has beneficial effects on cardiac function, geometry and neurohormonal status. Carvedilol is excreted by the liver and there were minimal fluctuations between hemodialysis, so, theoretically, drug dosage of the agent should be the same as in non-hemodialysis patients. Our results conflicted with prior studies, possibly caused by decreased circulation volume or plasma albumin level of hemodialysis patients, which would represent the effect of other drugs such as digoxin. Dosage adjustment and monitoring of drug plasma levels are required if the usual dosage of carvedilol is not tolerated in maintenance hemodialysis patients with asymptomatic left ventricular systolic dysfunction.
Nakayama
Masaru
M
Division of Cardiology, Kashima Hospital, Kashima-machi Shimokuramochi Aza-nakasawame 22-1, Iwaki, Fukushima 971-8143. ms-nakayama@kashima.jp
Ishii
Atsushi
A
Takeguchi
Fumihiro
F
Nakano
Hirofumi
H
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D002227:Carbazoles / Q000008:administration & dosage*; D000077261:Carvedilol; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D006435:Renal Dialysis; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol