Beta Blockers in Dialysis

Introduction to Beta Blocker Pharmacokinetics

The American Journal of Kidney Diseases recommends carvedilol for patients with dilated cardiomyopathy, as it reduces cardiovascular mortality, but increases the risk of intradialytic hypotension 4

The Kidney International journal notes that atenolol is significantly dialyzable, and demonstrates an increase in blood pressure after the first hemodialysis session, with fewer hospitalizations for heart failure compared to ACE inhibitors 1, 2, 3
The American Journal of Kidney Diseases states that carvedilol is not dialyzable, and reduces cardiovascular mortality in hemodialysis patients with dilated cardiomyopathy, but increases the risk of intradialytic hypotension 4

The American Journal of Kidney Diseases suggests that for patients with frequent intradialytic hypotension, non-dialyzable agents like propranolol and carvedilol should be avoided, and atenolol (dialyzable) should be administered after the dialysis session 4
For patients with stable intradialytic blood pressure, propranolol can be used but requires strict monitoring of potassium, and carvedilol is preferred for patients with severe dilated cardiomyopathy according to K/DOQI guidelines 4