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β-Blockers for Prevention of Sudden Cardiac Death in Patients on Hemodialysis: A Propensity Score Analysis of the HEMO Study
β-Blockers for Prevention of Sudden Cardiac Death in Patients on Hemodialysis: A Propensity Score Analysis of the HEMO Study
- Source :
- American Journal of Kidney Diseases. 58:939-945
- Publication Year :
- 2011
- Publisher :
- Elsevier BV, 2011.
-
Abstract
- Background Hemodialysis patients have an elevated risk of sudden cardiac death. Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure. Study Design Post hoc analysis of the Hemodialysis (HEMO) Study. Setting & Participants Participants enrolled in the HEMO Study from May 1995 to February 2001. Intervention β-Blocker use ascertained through self-reported questionnaires and dialysis clinic charts. Outcomes Sudden cardiac death adjudicated by a committee as a secondary outcome of interest. Measurements We used Cox proportional hazards regression models, competing risk survival analysis, propensity score matching, and covariate adjustment to study the association of β-blockers with sudden cardiac death. Results 1,747 patients were included in this study, and 521 were on β-blocker therapy at baseline. Mean age was 58 years, 57% were women, and 39% had ischemic heart disease (IHD) at baseline. Baseline β-blocker use was not associated with lower risk of sudden cardiac death in univariate (cause-specific HR, 0.89; 95% CI, 0.64-1.24), multivariable (cause-specific HR, 0.87; 95% CI, 0.62-1.22), or propensity-matched (cause-specific HR, 0.91; 95% CI, 0.55-1.50) analyses. There was a significant interaction between β-blocker use and sudden cardiac death (interaction P = 0.03) in patients with (cause-specific HR, 0.65; 95% CI, 0.42-1.01) and without IHD (cause-specific HR, 1.61; 95% CI, 0.92-2.80). Limitations Observational nature of the study. Conclusions In hemodialysis patients without preexisting IHD, β-blocker use was not associated with lower risk of sudden cardiac death. However, there was a trend toward benefit in those with IHD.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Adrenergic beta-Antagonists
Population
Comorbidity
Lower risk
Sudden cardiac death
Renal Dialysis
Risk Factors
Internal medicine
Diabetes Mellitus
medicine
Humans
Multicenter Studies as Topic
Propensity Score
education
Dialysis
Survival analysis
Proportional Hazards Models
education.field_of_study
Proportional hazards model
business.industry
Middle Aged
medicine.disease
Survival Analysis
Death, Sudden, Cardiac
Nephrology
Propensity score matching
Cardiology
Kidney Failure, Chronic
Female
Hemodialysis
business
Subjects
Details
- ISSN :
- 02726386
- Volume :
- 58
- Database :
- OpenAIRE
- Journal :
- American Journal of Kidney Diseases
- Accession number :
- edsair.doi.dedup.....6e6981838c4106f4d18e9f588bb6b187
- Full Text :
- https://doi.org/10.1053/j.ajkd.2011.06.024