biostudies-literatureUnknown4(5)Tella A<h4>Rationale & objective</h4>There is conflicting evidence regarding the type of β-blockers to use in dialysis patients. This systematic review seeks to determine whether highly dialyzable β-blockers are associated with higher rates of cardiovascular events and mortality in hemodialysis patients than poorly dialyzable β-blockers.<h4>Study design</h4>A systematic review of the existing literature was conducted. A meta-analysis was performed using data from the selected studies.<h4>Setting & study populations</h4>Participants were from the United States, Canada, and Taiwan. The mean ages of participants ranged from 55.9-75.7 years.<h4>Selection criteria for studies</h4>We searched the Ovid MEDLINE database from 1990 to September 2020. Studies without adult hemodialysis participants and without comparisons of at least 2 β-blockers of different dialyzability were excluded.<h4>Data extraction</h4>Baseline and adjusted outcome data were extracted from each study.<h4>Analytical approach</h4>Random-effects models were used to calculate pooled risk ratios using fully adjusted models from individual studies.<h4>Results</h4>Four cohort studies were included. Pooling fully adjusted models, highly dialyzable β-blockers did not influence mortality (HR, 0.94; 95% CI, 0.81-1.08; I² = 0.84) compared with poorly dialyzable β-blockers but were associated with a reduction in cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93). There was significant heterogeneity between studies (I² = 0.35). Only 1 study reported on adverse events. Intradialytic hypotension was more common in those on carvedilol (a poorly dialyzable β-blocker) compared with those on metoprolol (a highly dialyzable β-blocker; adjusted incidence rate ratio, 1.10; 95% CI, 1.09-1.11).<h4>Limitations</h4>No randomized controlled trials were identified. Each study used different analytic methods and different definitions for outcomes. Classifications of β-blockers varied. Only 1 study reported on adverse events.<h4>Conclusions</h4>Pooled data suggest highly dialyzable β-blockers are associated with similar mortality events and fewer cardiovascular events compared with poorly dialyzable β-blockers.Kidney medicine100460https://www.ebi.ac.uk/biostudies/studies/S-EPMC9079357biostudies-literatureβ-Blocker Use and Cardiovascular Outcomes in Hemodialysis: A Systematic Review.PMC9079357Vang WTella ARaju SIshani AIkeri ETaylor OMazanec MZhang Afalseβ-Blocker Use and Cardiovascular Outcomes in Hemodialysis: A Systematic Review.<h4>Rationale & objective</h4>There is conflicting evidence regarding the type of β-blockers to use in dialysis patients. This systematic review seeks to determine whether highly dialyzable β-blockers are associated with higher rates of cardiovascular events and mortality in hemodialysis patients than poorly dialyzable β-blockers.<h4>Study design</h4>A systematic review of the existing literature was conducted. A meta-analysis was performed using data from the selected studies.<h4>Setting & study populations</h4>Participants were from the United States, Canada, and Taiwan. The mean ages of participants ranged from 55.9-75.7 years.<h4>Selection criteria for studies</h4>We searched the Ovid MEDLINE database from 1990 to September 2020. Studies without adult hemodialysis participants and without comparisons of at least 2 β-blockers of different dialyzability were excluded.<h4>Data extraction</h4>Baseline and adjusted outcome data were extracted from each study.<h4>Analytical approach</h4>Random-effects models were used to calculate pooled risk ratios using fully adjusted models from individual studies.<h4>Results</h4>Four cohort studies were included. Pooling fully adjusted models, highly dialyzable β-blockers did not influence mortality (HR, 0.94; 95% CI, 0.81-1.08; I² = 0.84) compared with poorly dialyzable β-blockers but were associated with a reduction in cardiovascular events (HR, 0.88; 95% CI, 0.83-0.93). There was significant heterogeneity between studies (I² = 0.35). Only 1 study reported on adverse events. Intradialytic hypotension was more common in those on carvedilol (a poorly dialyzable β-blocker) compared with those on metoprolol (a highly dialyzable β-blocker; adjusted incidence rate ratio, 1.10; 95% CI, 1.09-1.11).<h4>Limitations</h4>No randomized controlled trials were identified. Each study used different analytic methods and different definitions for outcomes. Classifications of β-blockers varied. Only 1 study reported on adverse events.<h4>Conclusions</h4>Pooled data suggest highly dialyzable β-blockers are associated with similar mortality events and fewer cardiovascular events compared with poorly dialyzable β-blockers.2022-01-01T00:00:00Z2022 May2025-04-04T09:10:11.186Z2025-02-19T03:24:26.735ZS-EPMC90793573553943010.1016/j.xkme.2022.100460