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Beta-Blocker Prescriptions in Nondialysis-Dependent Patients with CKD: The French CKD-REIN Study
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Edité par CCSD -
International audience. Background:Beta-blockers (BB) are a heterogeneous drug class often prescribed to patients with moderate to severe CKD. We aimed at describing real-world BB prescription patterns in these patients.Methods:We analyzed 2,996 patients with CKD stages 2–5 under nephrology care from the CKD-REIN cohort study. BB prescriptions from any medical doctor were collected by clinical research associates based on anatomical therapeutic chemical (ATC) codes, as were patients’ demographic, clinical, and laboratory characteristics. Adverse drug reactions occurring during follow-up were adjudicated by a team of pharmacologists.Results:Compared with patients with no BB prescription (n=1733, 58%), patients on BB (n=1263, 42%) were older (median age 68 vs. 70 years, respectively), had a higher mean systolic BP (143 vs 140 mm Hg), lower mean heart rate (68 vs 74 bpm), and more comorbidities including diabetes (53% vs 36%), coronary disease (CD, 39% vs 14%), heart failure (HF, 21% vs 7%) and atrial fibrillation (AF, 17% vs 8%). Fourteen different BB agents were prescribed, mostly cardioselective (94%), lipophilic (78%), and non-vasodilatory (71%). Bisoprolol (572, 45.3%), nebivolol (296, 23.5%) and atenolol (179, 14.2%) were the most common agents. Bisoprolol was more often prescribed to patients with history of HF, CD or AF than to patients with no CV history (32.5% vs 56.5%). In contrast, nebivolol exhibited a different pattern, with fewer prescriptions in patients with CV history compared to those without (17.6% vs. 30%). Over the 5 years of follow-up, the rate of adverse drugs reactions attributed to BBs was 7.5 per 1000 person-years (PY), notably bradycardia (4.1 per 1000 PY).Conclusion:In pre-dialysis CKD patients, BB seems to be well-tolerated and commonly prescribed to high risk CV patients, with a preference for prescribing bisoprolol, nebivolol and atenolol.
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