According to a study published in the Journal of the American Society of Nephrology, dialysis patients receiving heart medications may be at a higher risk for premature death if they are easily removed from the circulation. The study looked at beta blockers, which is used to manage heart rhythm, treat angina and lower high blood pressure. These drugs differ in their dialyzability; some are filtered out more easily than others. Researchers suspect that beta blockers with high dialyzability do not provide full benefit for dialysis patients.
The study was led by Matthew Weir MD, FRCPC, MSc from Western University, in Ontario, Canada. He and his colleagues compared patients who were given beta blockers that were easily removed through dialysis to those who received beta blockers with low dialyzability. There were 3,294 patients in the group who received a beta blocker that is easily filtered out through dialysis with atenolol, acebutolol, or metoprolol. The comparison group was the same size and initiated dialysis with bisoprolol or propranolol. High dialyzability was associated with a 1.4 increased risk of dying compared to low dialyzability. There was no difference between these 2 groups of drugs in an analysis of 27,000 patients not receiving dialysis.
“Although we can’t draw causal relationships from our observational study, we did see the relationship that we hypothesized: the risk of death was higher in patients whose beta blocker was readily removed from their circulation by hemodialysis,” Dr. Weir said. “Changing prescriptions from an easily-removed drug to a difficult-to-remove drug might be a simple way to lower the risk of premature death for people receiving hemodialysis.”
Gautam Shroff and Charles Herzog of Hennepin County Medical Center and University of Minnesota, in Minneapolis said in an accompanying editorial that dialyzability should not be the only factor that clinicians consider when prescribing, as beta blockers have many features. They encouraged more research on the issue, stating “We firmly believe sufficient impetus is now present within the academic community for creation of a well-designed randomized controlled trial to compare specific beta blockers and their effects on all-cause mortality among dialysis patients, with sudden cardiac death as a prespecified adjudicated end point,”