International Journal of Nephrology and Renovascular Disease (Oct 2023)
Current Knowledge of Beta-Blockers in Chronic Hemodialysis Patients
Abstract
Intissar Haddiya,1,2 Siria Valoti3 1Department of Nephrology, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco; 2Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohamed Premier, Oujda, Morocco; 3Department of Medicine, Faculty of Medicine, Università degli Studi di Milano Statale, Milano, ItaliaCorrespondence: Intissar Haddiya, Department of Nephrology, Faculty of Medicine and Pharmacy, University Mohamed Premier, BP 724 Hay Al Quods, Oujda, 60000, Morocco, Tel +212 661 28 14 00, Email [email protected]: Beta-blockers include a large spectrum of drugs with various specific characteristics, and a well-known cardioprotective efficacy. They are recommended in heart failure, hypertension and arrhythmia. Their use in chronic hemodialysis patients is still controversial, mainly because of the lack of specific randomized clinical trials. Large observational studies and two important clinical trials have reported almost unanimously their efficacy in chronic hemodialysis patients, which seems to be related to their levels of dialyzability and cardioselectivity. A recent meta-analysis suggested that high dialyzable beta-blockers are correlated to a reduced risk of all-cause mortality and cardiovascular complications compared with low dialyzable beta-blockers. Despite their benefits, beta-blockers may have adverse effects, such as intradialytic hypotension with low dialyzability beta-blockers or the risk of sub-therapeutic plasma concentration of high dialyzable ones during dialysis sessions. Both cases are linked to adverse cardiovascular events. A solution for both high and low dialyzable drugs could be their administration after dialysis sessions. Futhermore, the bulk of existing literature seems to favor cardioselective beta-blockers with moderate-to-high dialyzability as the ideal agents in dialysis patients, but further, larger studies are needed. This review aims to analyze beta-blockers’ characteristics, indications and evidence-based role in chronic hemodialysis patients.Keywords: beta-blockers, hemodialysis, hypertension, mortality, intradialytic hypotension
