β-Blockers for prevention of sudden cardiac death in patients on hemodialysis: a propensity score analysis of the HEMO Study.

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.