Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2882 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
LETTER TO THE EDITOR  
Year : 2016  |  Volume : 27  |  Issue : 5  |  Page : 1057-1058
Beta-blockers control pulse rate during hemodialysis


Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan

Click here for correspondence address and email

Date of Web Publication22-Sep-2016
 

How to cite this article:
Ito K, Ookawara S, Ueda Y, Tabei K. Beta-blockers control pulse rate during hemodialysis. Saudi J Kidney Dis Transpl 2016;27:1057-8

How to cite this URL:
Ito K, Ookawara S, Ueda Y, Tabei K. Beta-blockers control pulse rate during hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 18];27:1057-8. Available from: http://www.sjkdt.org/text.asp?2016/27/5/1057/190901
To the Editor,

Tachycardia and bradycardia are signs of cardiac abnormalities. Hemodialysis (HD) patients have cardiac complications although the pulse rate (PR) of approximately 90% of HD patients is maintained within normal limits (60-99 beats/min) at the start of dialysis. [1] Furthermore, HD patients have a much higher risk of sudden cardiac death (SCD) and lethal arrhythmia than the general population. [2] These events occur between 0-12 and 60-72 h from the start of dialysis. [3] Although later events may be explained by fluid retention and hyperkalemia, the mechanisms triggering adverse events at the start of dialysis remain unclear. Beta-blocker (βB) usage over this time frame is lower than during other time points during dialysis. [3] There are few reports on the effect of βBs on PR during HD. Here, we investigated the differences in PR during HD in patients on treatment with or without βBs.

We conducted a cross-sectional study on maintenance HD patients (n = 85; mean age, 66 ± 10 years; mean HD duration, 5.4 ± 6.9 years). Inclusion criteria were a reduction in blood volume (BV) of more than 5% using a BV monitor on a Nikkiso DCS-27 dialysis machine (Tokyo, Japan) to confirm water removal to achieve adequate dry weight and no usage of digoxin. Patients were divided into two groups: 46 patients were receiving βB agents, whereas 39 persons were not. There was no difference in the clinical parameters examined including BV reduction (with βB, −10.9± 3.5%; without βB, −10.4 ± 3.6%), ultrafiltration rate (with βB, 630 ± 180 mL/h; without βB, 596 ± 209 mL/h), and total water removal (with βB, 2.1 ± 0.7 L/HD session; without βB, 2.0 ± 1.0 L/HD session). The prevalence rate of diabetes mellitus in the groups on treatment with or without βB group was 58% and 46%, respectively. The βBs used included carvedilol (74%), bisoprolol (20%), and metoprolol (6%).

Blood pressure (BP) and PR were monitored hourly. There was no significant difference in systolic and diastolic BP. However, PR between the two groups was significantly different during HD. In addition, PR was significantly lower during HD compared to the start of HD, in the group receiving βBs [Figure 1].
Figure 1: Blood pressure and pulse rate were monitored hourly in the two groups.

Click here to view


PR is influenced by many factors, especially sympathetic hyperactivity due to an increase in circulating plasma volume before HD. Water removal during HD often induces an increase in PR and various arrhythmias. Our results suggest that βB usage prevents cardiac sympathetic hyperactivity induced by HD, even in patients experiencing a BV reduction from water removal. These results may explain how βB usage could prevent SCD and arrhythmia during HD. Cice et al reported that carvedilol, a βB, can control PR over long periods of time, improve the two-year survival rate, and prevent adverse cardiac events. [4] Therefore, βB may have a cardioprotective effect in HD patients. However, we cannot conclude whether there are any beneficial effects on arrhythmia frequency or prognosis of HD patients. A larger longitudinal study is needed to clarify the role of βB agents in preventing SCD and lethal arrhythmia during HD.

Conflict of interest: None declared.

 
   References Top

1.
Nakai S, Masakane I, Akiba T, et al. Overview of regular dialysis treatment in Japan (as of 31 December 2005). Ther Apher Dial 2007;11: 411-41.  Back to cited text no. 1
[PUBMED]    
2.
Myerburg RJ, Mitrani R, Interian A Jr., Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: Design features and population impact. Circulation 1998;97: 1514-21.  Back to cited text no. 2
    
3.
Bleyer AJ, Hartman J, Brannon PC, ReevesDaniel A, Satko SG, Russell G. Characteristics of sudden death in hemodialysis patients. Kidney Int 2006;69:2268-73.  Back to cited text no. 3
    
4.
Cice G, Ferrara L, D'Andrea A, et al. Carvedilol increases two-year survival in dialysis patients with dilated cardiomyopathy: A prospective, placebo-controlled trial. J Am Coll Cardiol 2003;41:1438-44.  Back to cited text no. 4
[PUBMED]    

Top
Correspondence Address:
Dr. Susumu Ookawara
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama City
Japan
Login to access the Email id


DOI: 10.4103/1319-2442.190901

PMID: 27752023

Rights and Permissions


    Figures

  [Figure 1]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
    Article Figures
 

 Article Access Statistics
    Viewed1112    
    Printed4    
    Emailed0    
    PDF Downloaded148    
    Comments [Add]    

Recommend this journal