Clinical Researchβ-Blocker Dialyzability and Mortality in Older Patients Receiving HemodialysisWeir, Matthew A.*,†; Dixon, Stephanie N.†,‡,§; Fleet, Jamie L.†; Roberts, Matthew A.‖; Hackam, Daniel G.‡,¶; Oliver, Matthew J.**; Suri, Rita S.†,††; Quinn, Robert R.‡‡; Ozair, Sundus†; Beyea, Michael M.†; Kitchlu, Abhijat†; Garg, Amit X.*,†,‡,§ Author Information *Department of Medicine, Division of Nephrology, and ‡Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ¶Department of Medicine, Division of Clinical Neurosciences, Western University, London, Ontario, Canada; †Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; §Institute for Clinical Evaluative Sciences, London, Ontario, Canada; ‖Department of Renal Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; **Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada; ††Department of Medicine, University of Montreal, Montreal, Quebec, Canada; and ‡‡Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada Correspondence: Dr. Matthew A. Weir, ALL-139A University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada. Email: [email protected] Received April 2, 2014 Accepted July 12, 2014 Journal of the American Society of Nephrology 26(4):p 987-996, April 2015. | DOI: 10.1681/ASN.2014040324 Buy Metrics Abstract Some β-blockers are efficiently removed from the circulation by hemodialysis (“high dialyzability”) whereas others are not (“low dialyzability”). This characteristic may influence the effectiveness of the β-blockers among patients receiving long-term hemodialysis. To determine whether new use of a high-dialyzability β-blocker compared with a low-dialyzability β-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a high- versus low-dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). β-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study. Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.