Effects of Metoprolol versus Carvedilol on Intradialytic Hypotension and Heart Rate Variability in Patients with End-Stage Kidney Disease Undergoing Hemodialysis Betablocker, Intradialytic hypotension, Heart rate variability, Thailand
Conditions
Interventions
Metoprolol 50 mg bid to 100 mg bid ,Carvedilol 12.5 mg bid to 25 mg bid
Active Comparator Drug,Experimental Drug
Metoprolol group,Carvedilol group
Sponsors
Lampang hospital
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Inclusion criteria
Inclusion criteria: 1. Patients with end-stage kidney disease (ESKD) receiving maintenance hemodialysis three times per week. 2. Patients who have been receiving maintenance hemodialysis for at least 3 months. 3. Patients not currently receiving beta-blocker therapy with a pre-dialysis systolic blood pressure of 140 to179 mmHg. 4. Patients currently receiving beta-blocker therapy with a pre-dialysis systolic blood pressure of 130 to 159 mmHg. 5. Age 18 to 85 years at the time of enrollment.
Exclusion criteria
Exclusion criteria: 1.Resting heart rate less than 50 beats per minute. 2.History of second degree or third degree atrioventricular (AV) block. 3.History of heart failure with reduced ejection fraction (HFrEF) with left ventricular ejection fraction (LVEF) less than or equal to 40 percent. 4.LVEF less than or equal to 40 percent at study enrollment. 5.History of atrial fibrillation or permanent pacemaker implantation. 6.History of intradialytic hypotension occurring in more than 20 percent of hemodialysis sessions during the preceding 3 months. 7. Known hypersensitivity or allergy to betablockers 8. Active infection requiring ongoing treatment 9. Active malignancy requiring ongoing treatment 10. Pregnancy 11. History of severe adverse effects from betablockers or contraindications to betablocker therapy, including symptomatic bradycardia, asthma, chronic obstructive pulmonary disease (COPD), beta blocker induced bronchospasm, or severe Raynauds phenomenon. 12. Concomitant use of medications associated with an increased risk of bradycardia or heart block, such as verapamil or diltiazem
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of intradialytic hypotension At dialysis Blood pressure measurement,changes in heart rate variability (HRV) At intervention and 6 months after intervention Holter monitoring | — |
Secondary
| Measure | Time frame |
|---|---|
| Left ventricular mass index (LVMI) 6 and 12 months of treatment Echocardiography ,Intradialytic blood pressure At dialysis Blood pressure measurement ,Morning home blood pressure At start of intervention, 3 months, 6 months and 12 months of intervention Blood pressure measurement ,LVEF 6 and 12 months after intervention Echocardiography ,Global longitudinal strain (GLS) 6 and 12 months after intervention Echocardiography ,Echocardiographic indices of diastolic function 6 and 12 months after intervention Echocardiography,Severe IDH At dialysis Blood pressure measurement | — |
Countries
Thailand
Contacts
Public ContactThanawat Vongchaiudomchok
Department of internal medicine, Lampang hospital
Outcome results
None listed