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Kidney, cardiac, and safety outcomes of alpha blockers
- 1. Kidney, Cardiac, and Safety Outcomes Associated With Alpha Blockers in Patients With CKD BY: KHALED GHANAYEM DEPARTMENT OF INTERNAL MEDICINE G’, HAEMEK MEDICAL CENTER 1
- 3. OVERVIEW • Background • Methods • Design • Results • Discussion • Conclusion
- 4. OVERVIEW • Chronic kidney disease (CKD) is highly prevalent in the older population (>20%) • Hypertension (HTN) is nearly ubiquitous in this population (>80%) • In many cases a combination of blood pressure (BP) lowering medications are needed • Alpha-Blockers (AB) are reliable BP lowering meds
- 5. OVERVIEW • AB: Competitive inhibition of postsynaptic α1-adrenoreceptors of vascular smooth muscle • Vasodilation of veins and arterioles -> decrease in peripheral vascular resistance • AB in most cases are add-on therapy rather than 1st line • Concerns over side effects: • Orthostatic hypotension • Syncope • Falls • Fractures • Lack the reno-protective effects • Potent BP lowering capability
- 6. METHODS • Population-level, retrospective, matched cohort study • Conducted in Ontario, Canada • Study period 2007 – 2015 • BP lowering meds included: • Angiotensin-converting enzyme (ACE) inhibitors • Angiotensin II receptor blockers (ARBs) • Calcium channel blockers • β-blockers • Thiazide diuretics
- 7. DESIGN Inclusion Exclusion • Age: 66 or older • Previous HTN diagnosis (diagnostic code or BP lowering med prescription) • 2 estimated glomerular filtration rate (eGFR) assessments (CKD-EPI calc) • Prior AB use • History of: o Benign prostatic hyperplasia o Hypotension o Dialysis o Kidney transplantation • 1:1 high dimensional propensity score (HDPS) matching • Index event was new BP lowering med
- 9. OUTCOMES • Adverse kidney events: eGFR decline ≥ 30% • KRT - dialysis initiation or kidney transplantation • Cardiac events ◦ Acute MI ◦ PCI ◦ CHF ◦ Atrial fibrillation • All-cause mortality • Safety-related events – required hospitalization (hypotension, syncope, falls, and fractures).
- 10. RESULTS Pre-matching AB group had a higher proportion of: ‒ Men ‒ eGFR ‒ Diabetes + DM meds ‒ BP-lowering medications ‒ Statin use Post-matching • All characteristics were similar • Mean age – 76 y/o • Mean eGFR - 62 mL/min/1.73 m2
- 11. RESULTS – PATIENTS • Similar and diverse socioeconomic backgrounds • Nearly half study population eGFR 60 – 89 mL/min/1.73 m2 • Majority were on 4-5 BP lowering meds (60%+) • Most commonly used: ACE-I, CCB, and BB • Most widely use AB – Terazosin (66%) > Doxazosin (30%) > Prazosin
- 12. RESULTS – KIDNEY RELATED
- 13. RESULTS – EGFR DECLINE >30%
- 14. RESULTS – NEED FOR KRT
- 15. RESULTS – CARDIAC AND MORTALITY
- 16. RESULTS – CARDIAC EVENTS
- 17. RESULTS – ALL CAUSE MORTALITY
- 18. RESULTS – SAFETY RELATED
- 21. DISCUSSUION AB use was associated with: • Higher relative risk for ≥30% eGFR decline • Need for KRT • Reduced risk for cardiac events • All-cause mortality • Patients with lower eGFR benefited from AB • Lower eGFR = similar adverse events except syncope • Are ABs the real culprit for eGFR decline? • Need for AB = poor BP control?
- 22. LIMITAIONS • Observational study • Single state • No BP measurements available • Chance of AB use for urological symptoms • Adverse events required hospitalization • Index BP med could be the reason for results
- 23. CONCLUSION • Alpha blockers are potent blood pressure medications • In patients with low eGFR they hold a cardiac + mortality advantage • Consider avoiding in normal/at risk eGFR patients
- 25. THANK YOU FOR LISTINING!