Disclosures: Hundemer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
September 17, 2020
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Common hypertension drug linked to increased need for dialysis in patients with CKD

Disclosures: Hundemer reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Use of alpha-blockers – commonly prescribed to treat hypertension – was associated with eGFR decline in patients with chronic kidney disease, leading to an increased need for dialysis or transplantation.

Conversely, study results showed use of alpha-blockers decreased the risk for cardiac events in this patient population.

Alpha blockers for patients with CKD

“Alpha blockers are commonly prescribed as add-on therapy for resistant or refractory hypertension in patients with and without chronic kidney disease,” Gregory L. Hundemer, MD, MPH, of Ottawa Hospital and the University of Ottawa in Canada, and colleagues wrote. “Yet the association of alpha-blocker use, compared to alternative add-on blood pressure lowering agents, with long-term health outcomes in patients with chronic kidney disease remains unknown.”

According to the researchers, alpha-blockers are typically considered as an add-on therapy, rather than first-line therapy, “due to concerns surrounding their safety and efficacy.”

To better understand the impact of alpha-blocker use on patients with CKD, Hundemer and colleagues assessed 381,120 adults (at least 66 years of age) who were treated for hypertension between 2007 and 2015. Outcomes were compared between those newly prescribed alpha-blockers (doxazosin, terazosin, prazosin) and those prescribed alternative BP-lowering medications. Alternative medications consisted of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, beta blockers and thiazide diuretics.

Researchers considered a variety of outcomes including at least 30% eGFR decline; dialysis initiation or kidney transplantation; composite of acute myocardial infarction, coronary revascularization, congestive heart failure or atrial fibrillation; safety (eg, hypotension, syncope, falls, fractures) events; and mortality.

Findings indicated alpha-blocker use was associated with a higher risk for at least 30% eGFR decline (hazard ratio [HR] = 1.14), as well as an increased risk for requiring dialysis or kidney transplantation (HR = 1.28). Researchers noted the patient’s eGFR level did not modify these associations.

On the other hand, researchers observed alpha-blocker use to associated with a lower risk of cardiac events (also consistent across eGFR categories; HR = 0.92) and a lower mortality risk. However, the decreased mortality risk was seen only in patients with lower eGFRs (HR of 0.85 for eGFR 30 to 59 mL/min/m2 and 0.71 for eGFR < 30 mL/min/m2).

“These disparate results demonstrate the need for clinical trials to assess the safety and efficacy of [alpha-blocker] AB use in CKD,” Hundemer and colleagues concluded. “We suggest that close monitoring of kidney function in patients using AB is warranted and caution should be exercised when initiating a patient with CKD on AB therapy.”