E CHUNG 1,2, R LIN 2, K NEGISHI 3,4, M KOMALA 2
1Centre For Kidney Research, Westmead, Australia, 2Department of Nephrology, Nepean Hospital, Kingswood, Australia, 3Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia, 4Department of Cardiology, Nepean Hospital, Kingswood, Australia
Background: Patients with kidney failure requiring dialysis are at high risk of cardiovascular morbidity and mortality. The benefits and harms of beta-blockers on cardiovascular outcomes in patients on dialysis have not been recently summarised.
Methods: We searched MEDLINE, Embase and CENTRAL through August 2020. Risk of bias was assessed using the Cochrane tool and evidence certainty was evaluated using the GRADE process. Pre-specified outcomes were all-cause death, cardiovascular death, myocardial infarction, stroke, worsening heart failure, hospitalisation for cardiovascular cause, blood pressure, left ventricular mass-index (LVMI), left ventricular ejection fraction (LVEF), hypotension, hyperkalaemia and cardiac arrhythmias.
Results:Six studies (481 participants) were included. Beta blockers probably reduce the risk of all-cause death (2 studies, 163 participants, risk ratio (RR) 0.71 [95% confidence interval (CI) 0.53-0.96]; moderate certainty evidence) compared to placebo or no treatment but there were uncertain effects on cardiovascular death (2 studies, 163 participants, RR 0.45 [95% CI 0.04-5.13]; low certainty evidence), myocardial infarction (2 studies, 163 participants, RR 0.90 [95% CI 0.13-5.96]; low certainty evidence), systolic blood pressure (3 studies, 183 participants, mean difference (MD) -7.88 mmHg [95% CI -18.79 to 3.02]; very low certainty evidence), diastolic blood pressure (3 studies, 183 participants, MD -1.70 mmHg [95% CI -9.77 to 6.37]; very low certainty evidence) or LVEF (2 studies, 134 participants, MD 4.96% [95% CI -10.62 to 20.54]; very low certainty evidence). Data on stroke, worsening heart failure, hospitalisation for cardiovascular cause, hypotension, hyperkalaemia and cardiac arrhythmias were sparse or absent.
Conclusion:Beta blockers probably reduce the risk of death from any cause in people with kidney failure on dialysis but effects on other outcomes were uncertain.
Edmund is an adult nephrologist with a strong interest in glomerulonephritis and identifying strategies to limit the progression of chronic kidney disease. He completed a BMed MD at UNSW, MMed (Clin Epi) at The University of Sydney, and has worked with the Cochrane Kidney and Transplant Group on multiple systematic reviews to apply best evidence-based practice to his patients. He is currently undertaking a PhD with Prof Steven Alexander at the Centre for Kidney Research on regulatory T cells and other immunotherapies in primary membranous nephropathy with the goal of translating novel efficacious and less toxic treatments into clinical care.