α-Blocker Use in Hemodialysis: The Japan-Dialysis Outcomes and Practice Patterns Study (J-DOPPS)

Rationale & ObjectiveDespite alpha blockers’ use for hypertension as add-on therapy in hemodialysis patients, scant information is available on their association, especially with safety, these patients.Study DesignProspective cohort study.Setting ParticipantsHemodialysis patients receiving antihypertensive agents the Japan Dialysis Outcomes and Practice Patterns Study, Phases 4 to 6 were analyzed.ExposurePrimary exposure was prescription of alpha-blocking at baseline.OutcomesIncident fractures, falls, all-cause mortality.Analytical ApproachMultivariable Cox modified Poisson regression analysis.ResultsOf 5149 (mean age 65 years, 68% men) anti-hypertensive drugs, 717 (14%) received agents. During a mean follow-up period 2.0 247 525 498 deaths occurred. Multivariable analysis showed no significant association alpha-blocker increased risk fractures (hazard ratio (HR), 0.92(95% confidence interval (CI) 0.61-1.38)), falls (HR, 0.94(95%CI 0.74-1.20)), or 0.87(95%CI 0.64-1.20)) compared blocker non-use. Alpha-blocker was, however, significantly associated decreased mortality subgroup analysis, e.g, who older 0.71(95%CI 0.51-0.99)) female 0.68(95%CI 0.48-0.95)) had history cardiovascular disease 0.67(95%CI pre-dialysis blood pressure ≥140 mmHg 0.69(95%CI 0.49-0.98)).LimitationsSelection bias cannot be ruled out given prevalent user analysis.ConclusionsNo between worse safety-related outcomes seen, indicating that clinicians may safely prescribe alpha-blockers require lowering.