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The Intuitive Case for β-blockers in Patients with ESRD


Address correspondence to: Christopher T. Chan, Deputy Director, Division of Nephrology, University Health Network, R Fraser Elliott Chair in Home Dialysis; Associate Professor of Medicine, University of Toronto, Toronto General Hospital, 8th Floor Room 8EB842, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4, Tel.: + 1 416-340-3073, Fax: + 1 416-340-4999, or e-mail:


Sudden cardiac death (SCD) is common in dialysis patients accounting for up to 25% of all-cause mortality. Unlike in the general population, occlusive coronary artery disease is implicated in a minority of these deaths. Activation of the sympathetic nervous system is prevalent in the dialysis population and may underlie this high rate of SCD. β-blockers reduce SCD in the general population and, given their mode of action, β-blockers would seem to be an ideal class of agents to prevent SCD in dialysis patients. In this review, we will explore the etiology of SCD in dialysis patients and discuss the evidence supporting the use of β-blockers in patients with ESRD. We will also examine potential impediments to the use β-blocker in the dialysis population and outline directions for future trials in this area.