Beta-blocker prescription and outcomes in hemodialysis patients from the Japan Dialysis Outcomes and Practice Patterns Study.
OBJECTIVE
Given the clear benefits of mortality reduction observed for most beta-blockers in clinical trials, they are relatively underused in hemodialysis patients. Since the outcomes associated with the use of beta-blockers are not fully known, we investigated their effect on mortality among a cohort of hemodialysis patients.


METHODS
Data were analyzed from the Dialysis Outcomes and Practice Patterns Study phase II for 2,286 randomly selected patients on hemodialysis in Japan. Treatment with beta-blockers was the major predictor variable. The main outcome measure was all-cause mortality. Cox regression analysis was used to assess an association between treatment with beta-blockers and the risk of death.


RESULTS
247 patients (11.9%) were administered beta-blockers and 1,828 patients (88.1%) were not. Whereas patients treated with beta-blockers had a higher prevalence of hypertension and coronary heart disease, Kaplan-Meier analysis revealed that all-cause mortality rates were significantly (p < 0.007) decreased in patients treated with beta-blockers compared to those without. In multivariable, fully adjusted models, treatment with beta-blockers was also independently associated with reduced all-cause mortality (hazard ratio = 0.48; p = 0.02).


CONCLUSIONS
This study indicated a possible association between the use of beta-blockers and reduced risk of mortality in hemodialysis patients. These results should be confirmed in further randomized controlled trials.
Nakao
Kazushi
K
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. nakao_kazu@ybb.ne.jp
Makino
Hirofumi
H
Morita
Satoshi
S
Takahashi
Yoshimitsu
Y
Akizawa
Tadao
T
Saito
Akira
A
Asano
Yasushi
Y
Kurokawa
Kiyoshi
K
Fukuhara
Shunichi
S
Akiba
Takashi
T
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D038622:Internationality; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists