Beta-blockers improve survival in heart failure patients initiating dialysis

Use of beta-blockers appears to cut the risk of mortality in patients with heart failure (HF) who are starting either haemodialysis or peritoneal dialysis, as reported in a study.

The study included 3,503 adult patients with chronic kidney disease and HF. Of these, 2,115 (60.4 percent) were using beta-blockers when they transitioned to maintenance dialysis.

Outcomes examined were all-cause mortality within 6 months and hospitalization within 6 months after the transition to dialysis. Cox proportional hazard analysis and logistic regression were used to estimate the effect of beta-blocker treatment on the said outcomes. Additionally, inverse probability of treatment weights using propensity scores was applied in order to balance covariates between users and nonusers of beta-blockers.

Compared with nonusers, users were less likely to die of any cause within 6 months. Overall, any beta-blocker conferred a 21-percent risk reduction (hazard ratio [HR], 0.79, 95 percent confidence interval [CI], 0.65–0.94), whereas metoprolol lowered the risk by 32 percent (HR, 0.68, 95 percent CI, 0.53–0.88).

The protective benefit of beta-blockers was not observed for all-cause or cardiovascular-related hospitalization within 6 months.

The study was limited by its observational nature as well as the failure to fully account for residual confounding.