Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands (E.L.F., F.W.D.).
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands (A.U.).
Circ Heart Fail. 2020 Nov;13(11):e007180. doi: 10.1161/CIRCHEARTFAILURE.120.007180. Epub 2020 Oct 19.
It is unknown if β-blockers reduce mortality/morbidity in patients with heart failure (HF) and advanced chronic kidney disease (CKD), a population underrepresented in HF trials.
Observational cohort of HF patients with advanced CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m) from the Swedish Heart Failure Registry between 2001 and 2016. We first explored associations between β-blocker use, 5-year death, and the composite of cardiovascular death/HF hospitalization among 3775 patients with HF with reduced ejection fraction (HFrEF) and advanced CKD. We compared observed hazards with those from a control cohort of 15 346 patients with HFrEF and moderate CKD (estimated glomerular filtration rate <60-30 mL/min per 1.73 m), for whom β-blocker trials demonstrate benefit. Second, we explored outcomes associated to β-blocker among advanced CKD participants with preserved (HFpEF; N=2009) and midrange ejection fraction (HFmrEF; N=1514).
During a median follow-up of 1.3 years, 2012 patients had a subsequent HF hospitalization, and 2849 died in the HFrEF cohort, of which 2016 died due to cardiovascular causes. Among patients with HFrEF, β-blocker use was associated with lower risk of death (adjusted hazard ratio 0.85 [95% CI, 0.75-0.96]) and cardiovascular mortality/HF hospitalization (0.87 [0.77-0.98]) compared with nonuse. The magnitude of the associations was similar to that observed for HFrEF patients with moderate CKD. Conversely, no significant association was observed for β-blocker users in advanced CKD with HFpEF (death: 0.88 [0.77-1.02], cardiovascular mortality/HF hospitalization: 1.05 [0.90-1.23]) or HFmrEF (death: 0.95 [0.79-1.14], cardiovascular mortality/HF hospitalization: 1.09 [0.90-1.31]).
In HFrEF patients with advanced CKD, the use of β-blockers was associated with lower morbidity and mortality. Although inconclusive due to limited power, these benefits were not observed in similar patients with HFpEF or HFmrEF.
β 受体阻滞剂是否能降低合并晚期慢性肾脏病（CKD）的心力衰竭（HF）患者的死亡率/发病率尚不清楚，而这一人群在 HF 试验中代表性不足。
本研究为 2001 年至 2016 年间瑞典 HF 注册研究中合并晚期 CKD（估算肾小球滤过率＜30ml/min/1.73m）的 HF 患者的观察性队列研究。我们首先探讨了在 3775 例射血分数降低的 HF（HFrEF）合并晚期 CKD 患者中，β 受体阻滞剂的使用与 5 年死亡率和心血管死亡/HF 住院的复合终点之间的相关性，这些患者来自于一个控制队列，共 15346 例射血分数中度降低的 CKD（估算肾小球滤过率＜60-30ml/min/1.73m）患者，这些患者接受 β 受体阻滞剂治疗获益。其次，我们在合并保留射血分数的 HF（HFpEF；N=2009）和中间射血分数的 HF（HFmrEF；N=1514）的 CKD 晚期患者中，探讨了β 受体阻滞剂相关的结局。
在中位随访 1.3 年期间，2012 例患者发生了后续 HF 住院，在 HFrEF 队列中有 2849 例患者死亡，其中 2016 例死于心血管原因。在 HFrEF 患者中，与未使用者相比，β 受体阻滞剂使用者的死亡风险（校正风险比 0.85 [95%可信区间，0.75-0.96]）和心血管死亡率/HF 住院率（0.87 [0.77-0.98]）均较低。这些相关性的程度与中度 CKD 的 HFrEF 患者相似。相反，在晚期 CKD 合并 HFpEF（死亡：0.88 [0.77-1.02]，心血管死亡率/HF 住院：1.05 [0.90-1.23]）或 HFmrEF（死亡：0.95 [0.79-1.14]，心血管死亡率/HF 住院：1.09 [0.90-1.31]）的患者中，β 受体阻滞剂使用者并未观察到显著的相关性。
在合并晚期 CKD 的 HFrEF 患者中，β 受体阻滞剂的使用与较低的发病率和死亡率相关。尽管由于效力有限，结果尚不确定，但在具有相似 HFpEF 或 HFmrEF 的患者中并未观察到这些益处。
