β受体阻滞剂对CKD患者的死亡率无影响

圣迭戈——一项大型研究的结果显示，晚期慢性肾病患者使用β受体阻滞剂与全因死亡率或启动长期透析的风险降低无关。

Anna Jovanovich博士

丹佛市科罗拉多大学的Anna Jovanovich博士在2012肾脏周上报告：“慢性肾病和终末期肾病患者交感神经系统活性增加。这可能与死亡相关，当您的交感神经活性增高时，可能发生更多心律失常。您可能会认为β受体阻滞剂有助于降低交感神经活性，并因此降低死亡率，但在这项观察性研究中，我们没有看到这种相关性。”

Jovanovich博士及其合作者评估了参与2001~2006年肾脏和终末期肾病(HOST)同型半胱氨酸研究的1,099例晚期肾病但尚未接受透析治疗者的数据。患者的平均年龄为69岁，98%为男性，26%为非裔美国人，平均肾小球滤过率为18 ml/(min·1.73 m²)。在平均3年随访期间，453例患者(41%)发生全因死亡，615例患者(56%)开始接受长期透析治疗。

结果显示，校正年龄、性别、种族、吸烟状况、糖尿病、高血压、心血管疾病、体重指数、收缩压、白蛋白和GFR后，发现基线β受体阻滞剂的使用与全因死亡风险降低不相关(校正HR为 1.14；P=0.07)，也与启动长期透析治疗的风险降低无关(校正HR为0.90)。

研究者总结认为，使用β受体阻滞剂并不能降低慢性肾病患者的全因死亡率或减少对长期透析治疗的需求。因此，对于不伴心力衰竭的慢性肾病患者，或许应在尝试β受体阻滞剂之前选用其他降压药物。

Jovanovich博士披露无相关利益冲突，2012肾脏周由美国肾病学会主办。

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By: DOUG BRUNK, Cardiology News Digital Network

SAN DIEGO – Beta-blocker use by patients with advanced chronic kidney disease was not associated with a lower risk of all-cause mortality or initiation of chronic dialysis, results from a large study demonstrated.

"The sympathetic nervous system is increased in chronic kidney disease and end-stage renal disease," Dr. Anna Jovanovich said in an interview during a poster session at Kidney Week 2012. "That can be associated with mortality – you can have more arrhythmias when your sympathetic drive is higher. You would think that beta-blockers might help decrease the sympathetic drive and then decrease mortality, but from this observational study we don’t see that association."
 
Dr. Jovanovich, a second-year renal fellow at the University of Colorado, Denver, and her associates evaluated 1,099 advanced kidney disease patients not yet on dialysis who participated in the Homocysteine in Kidney and End-Stage Renal Disease (HOST) study, conducted between 2001 and 2006.

The mean age of patients was 69 years, 98% were male, 26% were African American, and the mean estimated glomerular filtration rate was 18 mL/min per 1.73 m2. During a mean follow-up of 3 years, 453 patients (41%) died from any cause and 615 (56%) started chronic dialysis.

After adjustment for age, gender, race, smoking status, diabetes, hypertension, cardiovascular disease, body mass index, systolic blood pressure, albumin, and eGFR, baseline beta-blocker use was not associated with lower risk of all-cause mortality (adjusted HR of 1.14; P = .07), nor was it associated with a lower risk of initiation of chronic dialysis (adjusted HR of 0.90).

"This is only an observational study so we can’t draw conclusions, but in a kidney disease patient who has heart failure, I think beta-blockers are an important medication in their armamentarium," she said. "However, in a kidney disease patient without heart failure there may be other blood pressure–lowering medications to try first before you try a beta-blocker."

Dr. Jovanovich said that the findings support those of the Hemodialysis Study (Am. J. Kidney Dis. 2011;58:939-45).

Dr. Jovanovich said that she had no relevant financial conflicts to disclose.

The meeting was sponsored by the American Society of Nephrology.