Weir Matthew A, Herzog Charles A
Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Semin Dial. 2018 May;31(3):219-225. doi: 10.1111/sdi.12691. Epub 2018 Feb 26.
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence. Despite these limitations, both trial and observational data exist that can help guide the use of these medications. In this review, we outline the reasons to consider beta blockers for patients receiving hemodialysis, discuss the barriers to their use, and provide specific evidence-based recommendations for beta blocker use in patients with heart failure, hypertension, ischemic heart disease and arrhythmia.
对于需要血液透析的患者，β受体阻滞剂在心血管疾病治疗中既带来了机遇，也带来了挑战。非透析人群的数据有力支持了β受体阻滞剂的使用，且其能直接缓解将慢性肾脏病与心血管后遗症联系起来的交感神经过度活跃。然而，支持在接受血液透析的患者中使用β受体阻滞剂的证据并不充分，而且β受体阻滞剂类别的异质性使得难以放心地开具这些药物。尽管存在这些局限性，但仍有试验和观察性数据可帮助指导这些药物的使用。在本综述中，我们概述了考虑为接受血液透析的患者使用β受体阻滞剂的理由，讨论了使用β受体阻滞剂的障碍，并针对心力衰竭、高血压、缺血性心脏病和心律失常患者使用β受体阻滞剂提供基于证据的具体建议。
