Background:
Post-hoc analysis of Randomized control trials have established safety and efficacy of Beta blockers (BB) in patients with systolic heart failure (HF) and mild to moderate Chronic kidney disease (CKD). However, the mortality benefit in patients with advanced CKD especially those approaching end stage renal disease (ESRD) is limited. The study was sought to identify mortality benefit in patients with Heart failure (HF) and ESRD who progressed to dialysis.
Methods:
Using electronic medical records, we identified 1,817 patients with end stage renal dialysis(ESRD) who progressed to dialysis over a 6 year period between 2004 and 2011. Kaplan Meyer survival curves were used to assess the association between BB use and mortality.
Results:
Of 1817 patients (mean age 61+/-15, 57% males) with ESRD who progressed to dialysis, 1329 (73.1%) were treated with BB and 488 (26.5%) were never treated with a BB. Kaplan Meyer Survival curves showed that patients who received treatment with BB had better survival than patients who were never treated with BB despite more HTN and diabetes present in the former group (mean survival time 4.9 years versus 4.4 years, p<0.001, Fig 1). Survival graphs were similar for those with an encounter diagnosis of HF (n=547, Fig 2) and those without an encounter diagnosis of HF (n=1270, graph not shown) with stronger association between BB and survival among those with HF (mean survival 3.1 versus 4.8 years, p=0.001, Fig 2).
Conclusion:
Treatment with BB is associated with improved survival in heart failure patients with ESRD who progressed to dialysis.
Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital