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.
N1 - Funding Information:
Support: Dr Tangri is supported by the KRESCENT Post-Doctoral Fellowship, a joint initiative of the Kidney Foundation of Canada, the Canadian Institute of Health Research and the Canadian Society of Nephrology. This work also is supported by the National Institute of Health grant K24 DK078204 .
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 - dialysis
KW - sudden cardiac death
KW - β-blockers
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U2 - 10.1053/j.ajkd.2011.06.024
DO - 10.1053/j.ajkd.2011.06.024
M3 - Article
C2 - 21872979
AN - SCOPUS:81755161496
SN - 0272-6386
VL - 58
SP - 939
EP - 945
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -