title: Effects of beta-adrenergic antagonists in patients with chronic kidney disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this systematic review was to study the benefits and risks of beta-adrenergic antagonists (beta-blockers) in patients with chronic kidney disease (CKD).
  
  
  BACKGROUND
  There is an excess burden of cardiovascular disease and death in people with CKD. Despite their potential benefits, the effects of beta-blockers in this population are uncertain.
  
  
  METHODS
  CENTRAL (Cochrane Central Register of Controlled Trials), Medline (Medical Literature Analysis and Retrieval System Online), and Embase (Excerpta Medical Database) were searched for randomized controlled trials with at least 3 months of follow-up in patients with CKD stages 3 to 5 that reported mortality outcomes. Summary estimates of effect were obtained using a random effects model.
  
  
  RESULTS
  Eight trials met criteria for review: 6 placebo-controlled trials involving 5,972 participants with chronic systolic heart failure and 2 angiotensin-converting enzyme inhibitor-comparator trials involving 977 participants not known to have heart failure. In CKD patients with heart failure, compared with placebo, beta-blocker treatment reduced the risk of all-cause (risk ratio [RR]: 0.72, 95% confidence interval [CI]: 0.64 to 0.80) and cardiovascular mortality (RR: 0.66, 95% CI: 0.49 to 0.89), but increased the risk of bradycardia (RR: 4.92, 95% CI: 3.20 to 7.55) and hypotension (RR: 5.08, 95% CI: 3.48 to 7.41). Quantitative meta-analysis was not performed for the non-heart failure studies due to substantial clinical diversity or lack of informative data.
  
  
  CONCLUSIONS
  Treatment with beta-blockers improved all-cause mortality in patients with CKD and chronic systolic heart failure. There is insufficient evidence to conclude whether people with CKD who are not known to have heart failure derive benefit from beta-blockers.
authors: Australasian Kidney Trials Network, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Sunil_Badve@health.qld.gov.au
authors: Sunil V
authors: SV
authors: Badve
authors: Matthew A
authors: MA
authors: Roberts
authors: Carmel M
authors: CM
authors: Hawley
authors: Alan
authors: A
authors: Cass
authors: Amit X
authors: AX
authors: Garg
authors: Henry
authors: H
authors: Krum
authors: Andrew
authors: A
authors: Tonkin
authors: Vlado
authors: V
authors: Perkovic
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D054143:Heart Failure, Systolic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
chemical_list: D000319:Adrenergic beta-Antagonists