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Beta-blockers benefit chronic kidney disease patients with heart failure

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Beta-blockers improve all-cause mortality in patients with chronic kidney disease (CKD) and heart failure, according to a report in the September 6th Journal of the American College of Cardiology.

“CKD patients with heart failure derive the same benefit from beta-blockers as those who have normal kidney function,” Dr. Sunil V. Badve from The University of Queensland, Brisbane, Queensland, Australia told Reuters Health in an email. “The study also highlights the absence of specific evidence in CKD patients without heart failure, particularly those undergoing dialysis and calls for randomized controlled trials.”

Dr. Badve and colleagues investigated the effects of beta-blockers on clinical endpoints in 9 reports of 8 trials involving 6949 patients with CKD stages 3 to 5 including those on dialysis.

In 6 trials that enrolled patients with heart failure, beta-blocker treatment reduced the risk of all-cause mortality by 28%. In post hoc analyses, the treatment effect was similar in CKD patients and in those without CKD.

Beta-blockers also significantly reduced the risk of cardiovascular mortality (by 34%) and the risk of sudden death (by 30%) in 4 trials that reported these outcomes. Beta-blockers did not affect the risk of all-cause hospitalization.

Data were inadequate to make conclusions about the effects of beta-blockers on mortality in non-heart failure studies.

In the heart failure studies, treatment with beta-blockers was associated with an increased risk of bradycardia and hypotension, compared with placebo.

“The findings of our systematic review and meta-analysis strongly support the use of beta-blockers in patients who have mild-to-moderate CKD and heart failure,” Dr. Badve concluded. “Although a few observational studies in CKD patients without heart failure have demonstrated better survival and cardiovascular outcomes with beta-blockers, the efficacy and safety of beta-blockers in this patient population has not been studied systematically in adequately powered randomized controlled trials. Till such evidence is available, we suggest cautious use of beta-blockers and the decision be based on case-to-case basis.”

Dr. Badve added, “Currently the Australasian Kidney Trials Network is recruiting participants in ‘the BLOCADE Feasibility Study’ which is a randomized double-blind placebo-controlled trial in patients undergoing dialysis to examine the efficacy, safety and tolerability of carvedilol, a non-selective beta-blocker (Australian New Zealand Clinical Trials Registry number ACTRN12609000174280). Dr. Matthew Roberts from Austin Health and the University of Melbourne, Australia is the principal investigator of this trial.”

“Nephrologists and cardiologists alike need evidence to inform practice and improve outcomes for the millions of patients worldwide with CKD and cardiovascular disease,” write Dr. Tara I. Chang and Dr. Glenn M. Chertow from Stanford University School of Medicine, Palo Alto, California in a related editorial. “The time is now for patients with all CKD stages, including patients on dialysis, to take center stage in future cardiovascular trials.”

Effects of Beta-Adrenergic Antagonists in Patients With Chronic Kidney Disease
J Am Coll Cardiol 2011;58:1152-1161,1162-1164.