Wu Ping-Hsun, Lin Yi-Ting, Liu Jia-Sin, Tsai Yi-Chun, Kuo Mei-Chuan, Chiu Yi-Wen, Hwang Shang-Jyh, Carrero Juan-Jesus
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin Kidney J. 2021 Jan 4;14(3):983-990. doi: 10.1093/ckj/sfaa248. eCollection 2021 Mar.
Despite widespread use, there is no trial evidence to inform β-blocker's (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients.
We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up.
Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60-0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80-0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77-0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72-0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93-1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs.
Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.
尽管β受体阻滞剂（BB）被广泛使用，但尚无试验证据可说明其在接受血液透析（HD）患者中的相对安全性和疗效。我们在此比较了卡维地洛或比索洛尔（这些患者中最常用的BB）使用相关的健康结局。
我们对2004年至2011年间开始使用比索洛尔的9305例HD患者和开始使用卡维地洛治疗的11171例HD患者进行了队列研究。我们比较了卡维地洛和比索洛尔使用者在2年随访期间全因死亡率和主要不良心血管事件（MACE）的风险。
开始使用比索洛尔的患者更年轻，透析时间更短，女性居多，有高血压和高脂血症等常见合并症，正在接受他汀类药物和抗血小板药物治疗，但与开始使用卡维地洛的患者相比，他们的心力衰竭和地高辛处方较少。在我们的观察期间，记录了1555例死亡和5167例MACE。在多变量调整的Cox模型中，与开始使用卡维地洛相比，开始使用比索洛尔与较低的全因死亡率相关{风险比[HR]0.66[95%置信区间（CI）0·60 - 0·73]}。在考虑死亡的竞争风险后，使用比索洛尔（与卡维地洛相比）与较低的MACE风险相关[HR 0.85（95% CI 0.80 - 0.91）]，这归因于较低的心力衰竭风险[HR 0.83（95% CI 0.77 - 0.91）]和缺血性卒中风险[HR 0.84（95% CI 0.72 - 0.97）]，但急性心肌梗死风险无差异[HR 1.03（95% CI 0.93 - 1.15）]。倾向评分匹配分析、分层分析以及考虑规定剂量或审查停止或更换BB的患者后进行的分析均证实了结果。
相对于卡维地洛，HD患者开始使用比索洛尔与较低的2年死亡和MACE风险相关，主要归因于较低的心力衰竭和缺血性卒中风险。
