Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis
B-blockers (BBs) are commonly used cardiovascular (CV) prevention medications in patients with end-stage kidney disease (ESKD) undergoing dialysis. Despite its widespread use, there is a lack of interventional evidence. The author Ping-Hsun Wu and colleagues conducted research titled “Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis” published in the Clinical Kidney Journal. The summary of the study is below:
Objective:
To investigate the association between the risk for all-cause mortality and CV events with the treatment of bisoprolol compared with carvedilol in HD patients.
Method:
A cohort of 9,305 HD patients and 11,171 HD patients, who initiated their treatment with bisoprolol and carvedilol between 2004 and 2011 are included in this study. Within 2-year follow-up, investigators compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users.
Findings:
The most commonly used BBs for HD patients in many countries are bisoprolol and carvedilol. The study reports bisoprolol initiation to be associated with a 20% lower risk of all-cause mortality and a 13% lower risk of MACEs in comparison to carvedilol. Additionally, both low dose (1.25–<10 mg/day), as well as high dose (10 mg/ day) of bisoprolol, was associated with a lower risk of all-cause mortality, MACEs, and heart failure. On the other hand, it is reported that carvedilol’s blood pressure– lowering effects might continue throughout the dialysis course, while the blood pressure–lowering effects of bisoprolol may decrease with decreasing circulating drug concentrations during HD therapy. Even though carvedilol has good metabolic effects and antioxidant properties compared to other BBs, its hypotensive side effects might act against its CV protective benefits. Lastly, as compared to nonselective BBs i.e. carvedilol and labetalol, cardioselective BBs i.e. atenolol and metoprolol were also found to reduce both all-cause and CV mortality.
Limitation:
This is an observational study and hence even after adjusting for potential cofounding, investigators unable to eliminate the influence of indication bias, coding errors, or misdiagnoses in administrative records. Investigators acknowledge the unavailability of some cofounders i.e. body mass index, echocardiography parameters, heart rate, lifestyle, blood pressure, and actual drug utility time. Due to which the effect of BBs on preserved ejection fraction was not evaluated. The authors also acknowledge that BB prescription does not guarantee that the patient complies with the treatment. Additionally, findings should be used with caution on other populations.
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