A Comparative Study of Carvedilol Versus Metoprolol Initiation and 1-Year Mortality Among Individuals Receiving Maintenance Hemodialysis.
A Comparative Study of Carvedilol Versus Metoprolol Initiation and 1-Year Mortality Among Individuals Receiving Maintenance Hemodialysis.
复制标题
在接受维持血液透析的个体中，卡维地醇与美托洛尔开始的比较研究。
DOI：
10.1053/j.ajkd.2018.02.350
复制
发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Flythe JE
中科院分区：
文献类型：
--
作者：
Assimon MM;Brookhart MA;Fine JP;Heiss G;Layton JB;Flythe JE
卡维地洛和美托洛尔是美国血液透析患者最常用的β受体阻滞剂，约占β受体阻滞剂处方的80%。尽管这两种药物在药理和药代动力学方面有很好的差异，但人们对它们在血液透析人群中的相对安全性和有效性知之甚少。采用新用户设计的回溯性队列研究。参加联邦医疗保险的血液透析患者在美国一家大型透析组织接受治疗，他们在2007年1月1日至2012年12月30日期间开始接受卡维地洛或美托洛尔治疗。卡维地洛与美托洛尔起始剂。在一年的随访期内，全因死亡率、心血管死亡率和传统低血压(血液透析期间的收缩压下降≥20毫米汞柱加上传统透析中的生理盐水注射)。生存模型用于估计死亡率分析中的危险比(HR)和95%可信区间(CI)。在传统的低血压分析中，使用泊松回归估计发生率比(IRR)和95%的顺应性。在所有分析中，治疗权重的逆概率被用来调整几个人口统计学、临床、实验室和透析治疗协变量。27064名接受维持性血液透析的患者包括：9558名(35.3%)卡维地洛起始剂和17506名(64.7%)美托洛尔起始剂。卡维地洛(与美托洛尔相比)与更高的全因死亡率(调整后HR，1.08；95%可信区间，1.02-1.16)和心血管死亡率(调整后HR，1.18；95%可信区间，1.08-1.29)相关。在亚组分析中，在高血压、房颤、心力衰竭和最近的心肌梗死患者中观察到了类似的相关性，这些患者是β-受体阻滞剂治疗的主要心血管适应症。在随访期间，卡维地洛(与美托洛尔相比)起始者在传统透析中低血压的发生率更高(调整后的IRR为1.10；95%CI为1.09-1.11)。可能存在残留混杂。与美托洛尔组相比，卡维地洛组的1年全因死亡率和心血管死亡率较高。这些发现的一个潜在机制可能是卡维地洛(与美托洛尔相比)开始治疗后透析中低血压的发生率增加。
Carvedilol and metoprolol are the beta-blockers most commonly prescribed to U.S. hemodialysis patients, accounting for approximately 80% of beta-blocker prescriptions. Despite well-established pharmacologic and pharmacokinetic differences between the two medications, little is known about their relative safety and efficacy in the hemodialysis population. A retrospective cohort study using a new-user design. Medicare-enrolled hemodialysis patients treated at a large U.S. dialysis organization who initiated carvedilol or metoprolol therapy from 01/01/2007 through 12/30/2012. Carvedilol versus metoprolol initiation. All-cause mortality, cardiovascular mortality and intradialytic hypotension (systolic blood pressure drop ≥20 mmHg during hemodialysis plus intradialytic saline administration) during a 1-year follow-up period. Survival models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in mortality analyses. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% CIs in intradialytic hypotension analyses. Inverse probability of treatment weighting was used to adjust for several demographic, clinical, laboratory and dialysis treatment covariates in all analyses. 27,064 individuals receiving maintenance hemodialysis were included: 9,558 (35.3%) carvedilol initiators and 17,506 (64.7%) metoprolol initiators. Carvedilol (versus metoprolol) initiation was associated with greater all-cause mortality (adjusted HR, 1.08; 95% CI, 1.02–1.16) and cardiovascular mortality (adjusted HR, 1.18; 95% CI, 1.08–1.29). In subgroup analyses, similar associations were observed among patients with hypertension, atrial fibrillation, heart failure, and a recent myocardial infarction, the main cardiovascular indications for beta-blocker therapy. During follow-up, carvedilol (versus metoprolol) initiators had a higher rate of intradialytic hypotension (adjusted IRR, 1.10; 95% CI, 1.09–1.11). Residual confounding may exist. Relative to metoprolol initiation, carvedilol initiation was associated with higher 1-year all-cause and cardiovascular mortality. One potential mechanism for these findings may be the increased occurrence of intradialytic hypotension after carvedilol (versus metoprolol) initiation.
登录
查看更多内容
影响因子：
2
作者：
Austin PC
通讯作者：
Austin PC
DOI：
10.1161/circoutcomes.113.000359
发表时间：
2013-09-01
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Brookhart MA;Wyss R;Layton JB;Stürmer T
通讯作者：
Stürmer T
影响因子：
2.8
作者：
Briasoulis, Alexandros;Palla, Mohan;Afonso, Luis
通讯作者：
Afonso, Luis
影响因子：
13.6
作者：
Chang, Tara I.;Paik, Jane;Chertow, Glenn M.
通讯作者：
Chertow, Glenn M.
影响因子：
6.1
作者：
Chou, Jason A.;Streja, Elani;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar