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

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32 Scopus citations

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 1 2011

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Keywords

  • dialysis
  • sudden cardiac death
  • β-blockers

ASJC Scopus subject areas

  • Nephrology

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