β-blockers for prevention of sudden cardiac death in patients on hemodialysis: A propensity score analysis of the HEMO study

Navdeep Tangri, Shani Shastri, Hocine Tighiouart, Gerald J. Beck, Alfred K. Cheung, Garabed Eknoyan, Mark J. Sarnak

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. Study Design: Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants: Participants enrolled in the HEMO Study from May 1995 to February 2001. Intervention: β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts. Outcomes: Sudden cardiac death adjudicated by a committee as a secondary outcome of interest. Measurements: We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death. Results: 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80). Limitations: Observational nature of the study. Conclusions: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.

Original languageEnglish (US)
Pages (from-to)939-945
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume58
Issue number6
DOIs
StatePublished - Dec 2011

Fingerprint

Propensity Score
Sudden Cardiac Death
Renal Dialysis
Myocardial Ischemia
Survival Analysis
Proportional Hazards Models
Observational Studies
Renal Insufficiency
Dialysis
Population

Keywords

  • β-blockers
  • dialysis
  • sudden cardiac death

ASJC Scopus subject areas

  • Nephrology

Cite this

β-blockers for prevention of sudden cardiac death in patients on hemodialysis : A propensity score analysis of the HEMO study. / Tangri, Navdeep; Shastri, Shani; Tighiouart, Hocine; Beck, Gerald J.; Cheung, Alfred K.; Eknoyan, Garabed; Sarnak, Mark J.

In: American Journal of Kidney Diseases, Vol. 58, No. 6, 12.2011, p. 939-945.

Research output: Contribution to journalArticle

Tangri, Navdeep ; Shastri, Shani ; Tighiouart, Hocine ; Beck, Gerald J. ; Cheung, Alfred K. ; Eknoyan, Garabed ; Sarnak, Mark J. / β-blockers for prevention of sudden cardiac death in patients on hemodialysis : A propensity score analysis of the HEMO study. In: American Journal of Kidney Diseases. 2011 ; Vol. 58, No. 6. pp. 939-945.
@article{8d1c814cc7854d07a1945ca30f33a1ec,
title = "β-blockers for prevention of sudden cardiac death in patients on hemodialysis: A propensity score analysis of the HEMO study",
abstract = "Background: Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. Study Design: Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants: Participants enrolled in the HEMO Study from May 1995 to February 2001. Intervention: β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts. Outcomes: Sudden cardiac death adjudicated by a committee as a secondary outcome of interest. Measurements: We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death. Results: 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57{\%} were women, and 39{\%} had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95{\%} CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95{\%} CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95{\%} CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95{\%} CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95{\%} CI, 0.92-2.80). Limitations: Observational nature of the study. Conclusions: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.",
keywords = "β-blockers, dialysis, sudden cardiac death",
author = "Navdeep Tangri and Shani Shastri and Hocine Tighiouart and Beck, {Gerald J.} and Cheung, {Alfred K.} and Garabed Eknoyan and Sarnak, {Mark J.}",
year = "2011",
month = "12",
doi = "10.1053/j.ajkd.2011.06.024",
language = "English (US)",
volume = "58",
pages = "939--945",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - β-blockers for prevention of sudden cardiac death in patients on hemodialysis

T2 - A propensity score analysis of the HEMO study

AU - Tangri, Navdeep

AU - Shastri, Shani

AU - Tighiouart, Hocine

AU - Beck, Gerald J.

AU - Cheung, Alfred K.

AU - Eknoyan, Garabed

AU - Sarnak, Mark J.

PY - 2011/12

Y1 - 2011/12

N2 - Background: Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. Study Design: Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants: Participants enrolled in the HEMO Study from May 1995 to February 2001. Intervention: β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts. Outcomes: Sudden cardiac death adjudicated by a committee as a secondary outcome of interest. Measurements: We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death. Results: 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80). Limitations: Observational nature of the study. Conclusions: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.

AB - Background: Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. Study Design: Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants: Participants enrolled in the HEMO Study from May 1995 to February 2001. Intervention: β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts. Outcomes: Sudden cardiac death adjudicated by a committee as a secondary outcome of interest. Measurements: We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death. Results: 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80). Limitations: Observational nature of the study. Conclusions: In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.

KW - β-blockers

KW - dialysis

KW - sudden cardiac death

UR - http://www.scopus.com/inward/record.url?scp=81755161496&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81755161496&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2011.06.024

DO - 10.1053/j.ajkd.2011.06.024

M3 - Article

C2 - 21872979

AN - SCOPUS:81755161496

VL - 58

SP - 939

EP - 945

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 6

ER -