Advertisement





Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2003; 41:1438-1444, doi:10.1016/S0735-1097(03)00241-9
© 2003 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cice, G.
Right arrow Articles by Calabrò, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cice, G.
Right arrow Articles by Calabrò, R.

CLINICAL RESEARCH

Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy

A prospective, placebo-controlled trial

Gennaro Cice, MD*,*, Luigi Ferrara, MD*, Antonello D’Andrea, MD*, Salvatore D’Isa, MD*, Attilio Di Benedetto, MD{dagger}, Antonio Cittadini, MD{ddagger}, Pina Elvira Russo, MD*, Paolo Golino, MD, PhD* and Raffaele Calabrò, MD*

* Division of Cardiology, Second University of Naples, Naples, Italy
{dagger} Fresenius Medical Care-Italia, Naples-NephroCare Group, Naples, Italy
{ddagger} Department of Internal Medicine, University Federico II, Naples, Italy

Manuscript received June 23, 2002; revised manuscript received November 25, 2002, accepted November 27, 2002.

* Reprint requests and correspondence: Dr. Gennaro Cice, Division of Cardiology, Second University of Naples, Piazza L, Miraglia, 2-80138 Naples, Italy.
gennarocice{at}hotmail.com

OBJECTIVES: We sought to evaluate the effects of carvedilol on mortality and morbidity in dialysis patients with dilated cardiomyopathy.

BACKGROUND: Several lines of evidence support the concept that therapy with beta-blocking agents reduces morbidity and mortality in patients with congestive heart failure (HF), but the demonstration of such a survival benefit in dialysis patients with dilated cardiomyopathy is still lacking.

METHODS: A total of 114 dialysis patients with dilated cardiomyopathy were randomized to receive either carvedilol or placebo in addition to standard therapy. A first analysis was performed at one year and was followed by an additional follow-up period of 12 months.

RESULTS: Two-year echocardiographic data revealed a significant attenuation of pathologic remodeling, with smaller cavity diameters and higher ejection fractions in the active treatment group than in the placebo group. At two years, 51.7% of the patients died in the carvedilol group, compared with 73.2% in the placebo group (p < 0.01). Furthermore, there were significantly fewer cardiovascular deaths (29.3%) and hospital admissions (34.5%) among patients receiving carvedilol than among those receiving a placebo (67.9% and 58.9%, respectively; p < 0.00001). The exploratory analyses revealed that fatal myocardial infarctions, fatal strokes, and hospital admissions for worsening HF were lower in the carvedilol group than in the placebo group. A reduction in sudden deaths and pump-failure deaths was also observed, though it did not reach statistical significance.

CONCLUSIONS: Carvedilol reduced morbidity and mortality in dialysis patients with dilated cardiomyopathy. These data suggest the use of carvedilol in all dialysis patients with chronic HF.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  BP = blood pressure
  CHF = congestive heart failure
  CI = confidence interval
  HF = heart failure
  HR = hazard ratio
  Kur = kurtosis
  LV = left ventricle/ventricular
  LVEDV = left ventricular end-diastolic volume
  LVEF = left ventricular ejection fraction
  LVESV = left ventricular end-systolic volume
  MI = myocardial infarction
  NYHA = New York Heart Association
  Ske = skewness




This article has been cited by other articles:


Home page
Eur Heart JHome page
M. K. de Bie, B. van Dam, A. Gaasbeek, M. van Buren, L. van Erven, J. J. Bax, M. J. Schalij, T. J. Rabelink, and J. W. Jukema
The current status of interventions aiming at reducing sudden cardiac death in dialysis patients
Eur. Heart J., July 1, 2009; 30(13): 1559 - 1564.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
A. A. Lopes, J. L. Bragg-Gresham, S. P. B. Ramirez, V. E. Andreucci, T. Akiba, A. Saito, S. H. Jacobson, B. M. Robinson, F. K. Port, N. A. Mason, et al.
Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS
Nephrol. Dial. Transplant., May 14, 2009; (2009) gfp212v1.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
M. P. Schlaich, F. Socratous, S. Hennebry, N. Eikelis, E. A. Lambert, N. Straznicky, M. D. Esler, and G. W. Lambert
Sympathetic Activation in Chronic Renal Failure
J. Am. Soc. Nephrol., May 1, 2009; 20(5): 933 - 939.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
R. Agarwal and A. D. Sinha
Cardiovascular Protection With Antihypertensive Drugs in Dialysis Patients: Systematic Review and Meta-Analysis
Hypertension, May 1, 2009; 53(5): 860 - 866.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
R. Kalaitzidis and G. Bakris
Should nephrologists use beta-blockers? A perspective
Nephrol. Dial. Transplant., March 1, 2009; 24(3): 701 - 702.
[Full Text] [PDF]


Home page
HeartHome page
N. Johnston, H. Dargie, and A. Jardine
Diagnosis and treatment of coronary artery disease in patients with chronic kidney disease
Heart, August 1, 2008; 94(8): 1080 - 1088.
[Full Text] [PDF]


Home page
NDT PlusHome page
M. M. Sood, R. P. Pauly, C. Rigatto, and P. Komenda
Left ventricular dysfunction in the haemodialysis population
NDT Plus, August 1, 2008; 1(4): 199 - 205.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
M. Chonchol, M. Benderly, and U. Goldbourt
Beta-blockers for coronary heart disease in chronic kidney disease
Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2274 - 2279.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
E. Ritz and C. Wanner
The Challenge of Sudden Death in Dialysis Patients
Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 920 - 929.
[Full Text] [PDF]


Home page
ICVTSHome page
K. Toda, K. Taniguchi, H. Matsue, and K. Yoshida
Novel adjunct to surgery for end-stage cardiomyopathy receiving hemodialysis
Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 272 - 274.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
A. Covic, P. Gusbeth-Tatomir, and D. Goldsmith
Negative outcome studies in end-stage renal disease: how dark are the storm clouds?
Nephrol. Dial. Transplant., January 1, 2008; 23(1): 56 - 61.
[Full Text] [PDF]


Home page
CJASNHome page
D. Banerjee, J. Z. Ma, A. J. Collins, and C. A. Herzog
Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload
Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1186 - 1190.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
O. Khawar, K. Kalantar-Zadeh, W. K. Lo, D. Johnson, and R. Mehrotra
Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?
Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1317 - 1328.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
F. Tentori, W. C. Hunt, M. Rohrscheib, M. Zhu, C. A. Stidley, K. Servilla, D. Miskulin, K. B. Meyer, E. J. Bedrick, H. K. Johnson, et al.
Which Targets in Clinical Practice Guidelines Are Associated with Improved Survival in a Large Dialysis Organization?
J. Am. Soc. Nephrol., August 1, 2007; 18(8): 2377 - 2384.
[Abstract] [Full Text] [PDF]


Home page
pdiHome page
P. J. Blankestijn
SYMPATHETIC HYPERACTIVITY--A HIDDEN ENEMY IN CHRONIC KIDNEY DISEASE PATIENTS
Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S293 - S297.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
P. H. Pun, R. W. Lehrich, S. R. Smith, and J. P. Middleton
Predictors of Survival after Cardiac Arrest in Outpatient Hemodialysis Clinics
Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 491 - 500.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
C. A. Herzog
Can We Prevent Sudden Cardiac Death in Dialysis Patients?
Clin. J. Am. Soc. Nephrol., May 1, 2007; 2(3): 410 - 412.
[Full Text] [PDF]


Home page
HypertensionHome page
J. Neumann, G. Ligtenberg, I. H.T. Klein, P. Boer, P. L. Oey, H. A. Koomans, and P. J. Blankestijn
Sympathetic Hyperactivity in Hypertensive Chronic Kidney Disease Patients Is Reduced During Standard Treatment
Hypertension, March 1, 2007; 49(3): 506 - 510.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
L. Segall and A. Covic
Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro haemodialysis
Nephrol. Dial. Transplant., January 1, 2007; 22(1): 59 - 63.
[Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
C. A. Herzog
Kidney disease in cardiology
Nephrol. Dial. Transplant., January 1, 2007; 22(1): 43 - 46.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
R. W. Lehrich, P. H. Pun, N. D. Tanenbaum, S. R. Smith, and J. P. Middleton
Automated External Defibrillators and Survival from Cardiac Arrest in the Outpatient Hemodialysis Clinic
J. Am. Soc. Nephrol., January 1, 2007; 18(1): 312 - 320.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
R. E. Gilbert, K. Connelly, D. J. Kelly, C. A. Pollock, and H. Krum
Heart Failure and Nephropathy: Catastrophic and Interrelated Complications of Diabetes
Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 193 - 208.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
T. Berl and W. Henrich
Kidney-Heart Interactions: Epidemiology, Pathogenesis, and Treatment
Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 8 - 18.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. K. Wali, G. S. Wang, S. S. Gottlieb, L. Bellumkonda, R. Hansalia, E. Ramos, C. Drachenberg, J. Papadimitriou, M. A. Brisco, S. Blahut, et al.
Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease
J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1051 - 1060.
[Abstract] [Full Text] [PDF]


Home page
Arch Intern MedHome page
K. C. Abbott, F. C. Trespalacios, L. Y. Agodoa, A. J. Taylor, and G. L. Bakris
{beta}-Blocker Use in Long-term Dialysis Patients: Association With Hospitalized Heart Failure and Mortality
Arch Intern Med, December 13, 2004; 164(22): 2465 - 2471.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
J. Neumann, G. Ligtenberg, L. Oey, H. A. Koomans, and P. J. Blankestijn
Moxonidine Normalizes Sympathetic Hyperactivity in Patients with Eprosartan-Treated Chronic Renal Failure
J. Am. Soc. Nephrol., November 1, 2004; 15(11): 2902 - 2907.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
J. G.F. Cleland, P. H. Loh, N. Freemantle, A. L. Clark, and A. P. Coletta
Clinical trials update from the European Society of Cardiology: SENIORS, ACES, PROVE-IT, ACTION, and the HF-ACTION trial
Eur J Heart Fail, October 1, 2004; 6(6): 787 - 791.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
J. A. Joles and H. A. Koomans
Causes and Consequences of Increased Sympathetic Activity in Renal Disease
Hypertension, April 1, 2004; 43(4): 699 - 706.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
H. A. Koomans, P. J. Blankestijn, and J. A. Joles
Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call
J. Am. Soc. Nephrol., March 1, 2004; 15(3): 524 - 537.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
F. Mallamaci, G. Tripepi, R. Maas, L. Malatino, R. Boger, and C. Zoccali
Analysis of the Relationship between Norepinephrine and Asymmetric Dimethyl Arginine Levels among Patients with End-Stage Renal Disease
J. Am. Soc. Nephrol., February 1, 2004; 15(2): 435 - 441.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y. W. Lew, and S. Tsimikas
Highlights of the year in JACC 2003
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2156 - 2166.
[Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
C. A. Herzog
How to Manage the Renal Patient with Coronary Heart Disease: The Agony and the Ecstasy of Opinion-Based Medicine
J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2556 - 2572.
[Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement