Abstract
Purpose: Cardiovascular disease is the leading cause of death in hemodialysis patients. Beta-blockers (gβ-blockers) have been shown to reduce cardiovascular morbidity and mortality in patients with coronary artery disease and heart failure. Available data demonstrate that end-stage renal disease patients are prescribed β-blockers much less often than are those with normal kidney function. The concern that these agents may lead to critical elevations in serum potassium (K) has led some nephrologists to avoid their use. This study evaluates the possible association between hyperkalemia and β-blocker use in stable hemodialysis patients. Methods: The records of 121 patients in an inner-city dialysis unit treated over a 3-month period were evaluated retrospectively. Patients taking β-blockers were compared to those who were not. Differences in age, incidence of diabetes mellitus, mean serum K level, use of β1-selective agents, dialysate concentration, and number and severity of hyperkalemic episodes were assessed. The highest K value recorded during the study period was used for each patient. Serum K levels greater than 6.5 mEq/L were defined as serious. Levels of this magnitude or greater were included in the analysis. Results: Only three patients were taking nonselective β-blockers. Twenty percent of patients in the β-blocker group had serum K levels greater than or equal to 6.5 mEq/L compared with 13.9% of those not taking β-blockers. A comparison of the two groups revealed no statistically significant difference in any of the parameters evaluated. Conclusion: The use of β1-selective agents does not appear to be associated with an increased incidence of serious hyperkalemia in hemodialysis patients. β-blockers should not be selectively withheld from hemodialysis patients for this reason.