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Effects of beta-adrenergic antagonists in patients with chronic kidney disease: A systematic review and meta-analysis

Badve, Sunil V., Roberts, Mathew A., Hawley, Carmel M., Cass, Alan, Garg, Amit X., Krum, Henry, Tonkin, Andrew and Perkovic, Vlado (2011). Effects of beta-adrenergic antagonists in patients with chronic kidney disease: A systematic review and meta-analysis. Journal of the American College of Cardiology,58(11):1152-1161.

Document type: Journal Article

IRMA ID 84473293xPUB45
Title Effects of beta-adrenergic antagonists in patients with chronic kidney disease: A systematic review and meta-analysis
Author Badve, Sunil V.
Roberts, Mathew A.
Hawley, Carmel M.
Cass, Alan
Garg, Amit X.
Krum, Henry
Tonkin, Andrew
Perkovic, Vlado
Journal Name Journal of the American College of Cardiology
Publication Date 2011
Volume Number 58
Issue Number 11
ISSN 0735-1097   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-80052365390
Start Page 1152
End Page 1161
Total Pages 10
Place of Publication United States
Publisher Elsevier Inc.
HERDC Category C1 - Journal Article (DIISR)
Abstract Objectives
The aim of this systematic review was to study the benefits and risks of beta-adrenergic antagonists (beta-blockers) in patients with chronic kidney disease (CKD).

Background

There is an excess burden of cardiovascular disease and death in people with CKD. Despite their potential benefits, the effects of beta-blockers in this population are uncertain.

Methods

CENTRAL (Cochrane Central Register of Controlled Trials), Medline (Medical Literature Analysis and Retrieval System Online), and Embase (Excerpta Medical Database) were searched for randomized controlled trials with at least 3 months of follow-up in patients with CKD stages 3 to 5 that reported mortality outcomes. Summary estimates of effect were obtained using a random effects model.

Results

Eight trials met criteria for review: 6 placebo-controlled trials involving 5,972 participants with chronic systolic heart failure and 2 angiotensin-converting enzyme inhibitor–comparator trials involving 977 participants not known to have heart failure. In CKD patients with heart failure, compared with placebo, beta-blocker treatment reduced the risk of all-cause (risk ratio [RR]: 0.72, 95% confidence interval [CI]: 0.64 to 0.80) and cardiovascular mortality (RR: 0.66, 95% CI: 0.49 to 0.89), but increased the risk of bradycardia (RR: 4.92, 95% CI: 3.20 to 7.55) and hypotension (RR: 5.08, 95% CI: 3.48 to 7.41). Quantitative meta-analysis was not performed for the non–heart failure studies due to substantial clinical diversity or lack of informative data.

Conclusions

Treatment with beta-blockers improved all-cause mortality in patients with CKD and chronic systolic heart failure. There is insufficient evidence to conclude whether people with CKD who are not known to have heart failure derive benefit from beta-blockers.
DOI http://dx.doi.org/10.1016/j.jacc.2011.04.041   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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