Related Experiment Video

Updated: Oct 13, 2025

Surgical Placement of Catheters for Long-term Cardiovascular Exercise Testing in Swine
12:37

Surgical Placement of Catheters for Long-term Cardiovascular Exercise Testing in Swine

Published on: February 9, 2016

13.6K

Effect of Beta-Blocker Cardioselectivity on Vascular Refilling in Hemodialysis Patients

Marta Álvarez Nadal1, Elizabeth Romelia Viera Ramírez1, María García Vallejo1

  • 1Department of Nephrology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.

Cardiorenal Medicine
|November 16, 2021
PubMed

Insights

Beta-blockers increase intradialytic hypotension risk in hemodialysis patients. Carvedilol specifically impairs vascular refilling, suggesting caution with its use before dialysis.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Beta-blockers are commonly prescribed for cardioprotection in hemodialysis (HD) patients, despite limited evidence.
  • The impact of beta-blockers on vascular refilling during HD and the specific effects of carvedilol remain unclear.

Purpose of the Study:

  • To evaluate the effects of beta-blockers on vascular refilling in HD patients.
  • To compare the impact of carvedilol versus other beta-blockers on vascular refilling and intradialytic hypotension risk.

Main Methods:

  • A prospective crossover study was conducted on maintenance HD patients.
  • Vascular refilling volume (Vref) and fraction (Fref) were measured with and without beta-blocker effects.
  • Patients were categorized into beta-blocker (βb) and non-beta-blocker (non-βb) profiles, with a subgroup analysis for carvedilol.

Main Results:

  • The beta-blocker profile showed a non-significant trend towards lower Vref and higher arterial blood pressure drop.
  • A significant increase in Fref was observed in the non-βb profile compared to the βb profile (p=0.015).
  • Beta-blocker use significantly increased the risk of intradialytic hypotension (IDH) (RR 2.40). Carvedilol specifically impaired Vref, Fref, and refilling rate.

Conclusions:

  • Administering beta-blockers before HD is associated with increased IDH risk and reduced Fref.
  • Carvedilol use during dialysis impairs vascular refilling, potentially due to its noncardioselective and poorly dialyzable properties.
  • Findings suggest a need for careful consideration of beta-blocker use, particularly carvedilol, in HD patients.
Abstract

Keywords:
Absolute blood volumeCarvedilolHemodialysisIntradialytic morbid eventsVascular refillingβ-Blocker

More Related Videos

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis04:36

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Published on: October 2, 2020

2.3K
Assessment of Vascular Function in Patients With Chronic Kidney Disease08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

16.4K

Related Concept Videos

Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
481
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
567
Antihypertensive Drugs: Types of β-Blockers01:28

Antihypertensive Drugs: Types of β-Blockers

β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and...
1.0K
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
527
Antihypertensive Drugs: Action of β1 Blockers01:17

Antihypertensive Drugs: Action of β1 Blockers

β1-receptors are primarily located in the heart and kidneys. In cardiac myocytes, these receptors interact with neurotransmitters released by the sympathetic nervous system during heightened activity or danger. As a result, β1-receptors get activated, initiating a series of biochemical processes. Excessive activation of beta receptors due to chronic stress can abnormally increase heart rate and contractility, resulting in high blood pressure or hypertension. To counteract this,...
907
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
48