Carvedilol vs Metoprolol: Mortality Risk Examined Among Hemodialysis Patients

A total of 27,064 individuals receiving hemodialysis were included in the study
A total of 27,064 individuals receiving hemodialysis were included in the study

Among hemodialysis patients, treatment with carvedilol was associated with higher all-cause and cardiovascular mortality compared with metoprolol. The finding comes from a retrospective study published in the American Journal of Kidney Disease

For this study, researchers sought to investigate the impact of carvedilol vs metoprolol initiation on 1-year mortality among patients receiving hemodialysis. Using data from a large US dialysis organization, the researchers evaluated patients who initiated carvedilol or metoprolol from January 2007 to December 2012.  

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A total of 27,064 individuals were included in the study; 9558 (35.3%) and 17506 (64.7%) initiated carvedilol and metoprolol, respectively. Outcomes were assessed at a 1-year follow-up. Results showed that compared to metoprolol, those who initiated carvedilol had a greater all-cause (adjusted HR, 1.08; 95% CI,1.02-1.16) and cardiovascular mortality (adjusted HR, 1.18; 95% CI, 1.08-1.29). Additionally, carvedilol initiators had a higher rate of intradialytic hypotension (adjusted incidence rate ratio 1.10; 95% CI, 1.09-1.11). 

Among patients with hypertension, atrial fibrillation, heart failure, and recent myocardial infarction (the main cardiovascular indications for β-blocker treatment), similar associations were observed.

The authors concluded that, "one potential mechanism for these findings may be the increased occurrence of intradialytic hypotension after carvedilol (vs metoprolol) initiation."

For more information visit AJKD.org.