Comparing Metoprolol Succinate and Carvedilol for Heart and Kidney Health in Hemodialysis Patients

What this Trial Is About

Researchers are evaluating two types of beta blockers, metoprolol succinate and carvedilol, in patients with end-stage kidney disease ESKD who are on hemodialysis. This study aims to find out if metoprolol succinate, which is dialyzable and beta-1 selective, leads to better cardiovascular outcomes compared to carvedilol, which is non-dialyzable, non-selective, and also blocks alpha-1 receptors. The study addresses the high cardiovascular risks faced by veterans with ESKD and seeks to improve survival and reduce heart-related complications. Participants will be randomly assigned to receive either metoprolol succinate or carvedilol. Dosing depends on the type and baseline dose of beta blocker previously used, with metoprolol succinate given once daily in doses ranging from 12.5 mg to 200 mg, and carvedilol given twice daily in doses from 3.125 mg to 50 mg depending on weight. The study will compare these treatments over an average follow-up period of three years. During the study, researchers will monitor participants for major cardiovascular events, such as heart attacks, strokes, hospitalizations for heart failure, and overall survival. The time from randomization to these events will be tracked. Care is taken to ensure treatment orders are updated and participants continue receiving their assigned medication through the VA pharmacy. The study enrollment started in May 2024, and participants will be followed for about three years to assess outcomes and safety.

CSP #2026 - Beta Blocker Dialyzability on Cardiovascular Outcomes