Alpha blockers do not increase the risk for falls, fractures, or death in the hemodialysis population, a new observational study concludes.
In phases 4 to 6 of the Japan Dialysis Outcomes and Practice Patterns (J-DOPPS) Study, 5149 patients on hemodialysis (mean age 65 years, 68% men) received anti-hypertensive drugs, including 717 patients (14%) prescribed alpha blockers such as doxazosin, bunazosin, prazosin, or urapidil. During a mean 2 years of follow-up, 247 fractures, 525 falls, and 498 deaths occurred in the overall cohort.
Multivariable analysis of the intent-to-treat population showed that patients prescribed alpha blockers had no higher risks of falls or fractures than patients not prescribed these agents, Ken Iseri, MD, PhD, of Showa University School of Medicine in Tokyo, Japan, and colleagues reported in Kidney Medicine. This result included patients at greater risk for falls due to advanced age, systolic blood pressure less than 140 mmHg, anemia, low body mass index, or large fluid removal volume.
“The face-to-face meeting with nephrologists three times per week may permit avoidance of undesirable events through achievement of optimal blood pressure management,” Dr Iseri’s team suggested. Pre-dialysis blood pressure levels were significantly higher in alpha blocker users, indicating that these agents were commonly prescribed for resistant or refractory hypertension.
Alpha blockers also conferred no higher risk for all-cause mortality in the total hemodialysis population, the investigators reported. Alpha blockers were significantly associated with a decreased risk of death among older patients (by 29%), women (32%), patients with a cardiovascular disease history (33%), and those with a pre-dialysis systolic blood pressure of 140 mmHg or greater (31%).
“We could not fully explain why this favorable effect was found only in specific hemodialysis populations, but not in total populations,” Dr Iseri’s team wrote. “However, recent studies have shown that alpha blockers may prevent cardiac remodeling and the development and progression of heart failure and have protective benefits against hyperinflammation and cytokine storm syndrome.”
Since this was an observational study of a single ethnicity and lacked data on patient strength, frailty, history of hypotension, bone mineral density, medication adherence, and other factors, more research is needed.
Iseri K, Miyakoshi C, Joki N, et al. α-blocker use in hemodialysis: The Japan-Dialysis Outcomes and Practice Patterns Study (J-DOPPS). Kidney Med. Published online July 3, 2023. doi:10.1016/j.xkme.2023.100698