Gregory L Hundemer

Background Despite a lack of clinical trial data, β-blockers are widely prescribed to dialysis patients. Whether specific β-blocker agents are associated with improved long-term outcomes compared to alternative β-blocker agents in the dialysis population remains uncertain. Methods We analyzed data from an international cohort study of 10,125 patients on maintenance hemodialysis across 18 countries that were newly prescribed a β-blocker medication within the Dialysis Outcomes and Practice Patterns Study (DOPPS). The following β-blocker agents were compared: metoprolol, atenolol, bisoprolol, and carvedilol. Multivariable Cox proportional hazards models were used to estimate the association between the newly prescribed β-blocker agent and all-cause mortality. Stratified analyses were performed on patients with and without a prior history of cardiovascular disease. Results The mean (SD) age in the cohort was 63 (15) years and 57% of participants were male. The most commonly prescribed β-blocker agent was metoprolol (49%) followed by carvedilol (29%), atenolol (11%), and bisoprolol (11%). Compared to metoprolol, atenolol (adjusted hazard ratio [HR] 0.77 [95% CI 0.65-0.90]) was associated with a lower mortality risk. There was no difference in mortality risk with bisoprolol (adjusted HR 0.99 [95% CI 0.82-1.20]) or carvedilol (adjusted HR 0.95 [95% CI 0.82-1.09]) compared to metoprolol. These results were consistent upon stratification of patients by presence or absence of a prior history of cardiovascular disease. Conclusions Among patients on maintenance hemodialysis who were newly prescribed β-blocker medications, atenolol was associated with the lowest mortality risk compared to alternative agents.