NDT Advance Access originally published online on January 10, 2008
Nephrology Dialysis Transplantation 2008 23(7):2274-2279; doi:10.1093/ndt/gfm950
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Beta-blockers for coronary heart disease in chronic kidney disease
1 Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Box C-281, Denver, CO 80262, USA 2 The Israel Society for the Prevention of Heart Attacks 3 Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer 4 Division of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Correspondence and offprint requests to: Michel B. Chonchol, Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Box C-281, Denver, CO 80262, USA. Tel: +1-303-399-6997; Fax: +1-303-399-3131; E-mail: Michel.Chonchol{at}uchsc.edu
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Abstract |
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Background. Limited data exist on whether the cardioprotective benefit of β-blockers is modified by the presence of chronic kidney disease (CKD).
Methods. A post hoc analysis of the data from the Bezafibrate Infarction Prevention (BIP) study was performed. CKD was defined according to the Modification of Diet in Renal Disease (MDRD) equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2. The Cox proportional hazard model, including adjustment for propensity score, was used to estimate the hazard ratios (HR) for the composite endpoint combining acute myocardial infarction (AMI) or sudden cardiac death (SCD).
Results. In this cohort of 3075 coronary heart disease (CHD) patients, 568 (18.5%) had CKD and 1185 (38.5%) were treated with β-blockers. A total of 245 (43.1%) CKD patients received β-blockers at baseline. The mean (± SD) estimated GFR in the CKD and non-CKD subgroups was 55 (± 4) and 73 (± 9) mL/min/1.73 m2, respectively. After a median follow-up of 6.2 years, the crude incidence rates of AMI or SCD/1000 person years (PY) were 25.6, 21.9, 34.6 and 27.5 for the β-blockers–/CKD–, β-blockers+/CKD–, β-blockers–/CKD+ and β-blockers+/CKD+ groups, respectively. Compared to patients with β-blockers–/CKD–, the adjusted HR of AMI or SCD was 0.87 (90% CI 0.71–1.06) for the β-blockers+/CKD–, 1.35 (90% CI 1.05–1.73) for the β-blockers–/CKD+ and 1.06 (90% CI 0.76–1.46) for the β-blockers+/CKD+.
Conclusions. These analyses suggest that the use of β-blockers is associated with a reduction in event risk in patients with CHD regardless of the presence or absence of CKD.
Keywords: cardiovascular mortality; chronic kidney disease; β-blockers
Received for publication: 4. 4.07
Accepted in revised form: 21.12.07