Use of Beta-Blockers on Maintenance Dialysis Patients and Ischemic Cerebral and Cardiovascular Deaths: An Examination Using Propensity Score.

Beta-blockers are frequently used in dialysis patients because of their cardioprotective properties. However, the effect of beta-blockers on reducing dialysis mortality has not been sufficiently examined to date. Thus, we sought to examine the effects on cardiovascular prognosis of beta-blockers using our outpatient dialysis database. From 389 dialysis patients registered in our database, subjects taking beta-blockers were extracted and matched with patients not taking beta-blockers using propensity scores based on 39 variables. Cardiovascular mortality, mortality of heart failure/sudden cardiac death, and mortality of ischemic cerebral and cardiovascular death were estimated using Kaplan-Meier method, and a log-rank test was used to analyze the difference between these survival curves for significance. A total of 216 patients, 108 matched pairs, were extracted from the whole cohort. There was no difference in background factors between the two groups. During mean observation periods of 4.4 years, 76 patients died, including 51 cases of cardiovascular death. Cardiovascular deaths included 30 heart failure/sudden deaths and 13 ischemic cerebral and cardiovascular deaths. For both cardiovascular and heart failure/sudden death, the survival curves did not indicate a significant difference between the 2 groups. On the contrary, in case of ischemic cerebral and cardiovascular deaths, 11 patients died in the beta-blocker group, with a significantly poor prognosis observed in the survival curve (p = 0.0132). Through the use of beta-blockers, a significant increase in ischemic cerebral and cardiovascular deaths was observed. The administration of beta-blockers to dialysis patients was found to worsen the cardiovascular prognosis, so sufficient examination will be needed in the future.