title: β-Blocker dialyzability and mortality in older patients receiving hemodialysis.
abstract: Some β-blockers are efficiently removed from the circulation by hemodialysis ("high dialyzability") whereas others are not ("low dialyzability"). This characteristic may influence the effectiveness of the β-blockers among patients receiving long-term hemodialysis. To determine whether new use of a high-dialyzability β-blocker compared with a low-dialyzability β-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a high- versus low-dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). β-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study.
authors.affiliation: Department of Medicine, Division of Nephrology, and Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; matthew.weir@lhsc.on.ca.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Weir
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada;
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dixon
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Fleet
authors.affiliation: Department of Renal Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia;
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Roberts
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Medicine, Division of Clinical Neurosciences, Western University, London, Ontario, Canada;
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.affiliation: Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada; and.
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
authors.affiliation: Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
authors.forename: Sundus
authors.initials: S
authors.lastname: Ozair
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
authors.forename: Michael M
authors.initials: MM
authors.lastname: Beyea
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
authors.forename: Abhijat
authors.initials: A
authors.lastname: Kitchlu
authors.affiliation: Department of Medicine, Division of Nephrology, and Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada;
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D009864:Ontario / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: cardiovascular disease; hemodialysis; mortality; pharmacokinetics