β-Blockers are known to improve postoperative outcome after major vascular surgery. We studied the effects of β-blockers in 2126 vascular surgery patients with and without kidney disease followed for 14 years. Creatinine clearance was calculated using the Cockcroft-Gault equation, and kidney function was categorized as Stage 1 for a reference group of 550 patients, Stage 2 with 808 patients, Stage 3 with 627 patients, and combined Stages 4 and 5 with 141 patients. Outcome measures were 30-day and long-term all-cause mortality with a mean follow-up of 6 years. Cox proportional hazards models were used to control cardiovascular risk factors, including propensity for β-blocker use. In all, 129 (6%) and 1190 (56%) patients died respectively. Mortality rates were three- and two-fold higher, respectively, for patients at Stages 3-5 compared to the reference group for the two outcomes. β-Blocker use was significantly associated with a lower risk of mortality after surgery. The overall adjusted hazard ratio was 0.35 and 0.62, respectively, for individuals at Stages 3-5 compared to the reference group for 30-day and long-term mortality. This study shows that kidney function is a predictor of all-cause mortality and β-blocker use is associated with a lower risk of death in kidney disease patients undergoing elective vascular surgery.

Cardiovascular disease, Creatinine clearance, Kidney disease, Survival, Vascular surgery, β-blockers
dx.doi.org/10.1038/sj.ki.5002554, hdl.handle.net/1765/35080
Kidney International
Erasmus MC: University Medical Center Rotterdam

Welten, G.M.J.M, Chonchol, M, Hoeks, S.E, Schouten, O, Bax, J.J, Dunkelgrun, M, … Poldermans, D. (2007). β-Blockers improve outcomes in kidney disease patients having noncardiac vascular surgery. Kidney International, 72(12), 1527–1534. doi:10.1038/sj.ki.5002554