Association of non-selective β blockers with the development of renal dysfunction in liver cirrhosis: a systematic review and meta-analysis

Abstract

Background & Aims

Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output. This study aimed to systematically investigate their association.

Methods

PubMed, EMBASE, and Cochrane library databases were searched to identify all relevant studies evaluating the association of NSBBs with renal dysfunction in cirrhotic patients. Unadjusted and adjusted data were separately extracted. Odds ratios (ORs) and hazard ratios (HRs) were pooled. Subgroup meta-analyses were performed according to the proportions of ascites and Child-Pugh class B/C and the mean model for end-stage liver disease (MELD) score. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

Results

Fourteen studies were finally included. Based on unadjusted data, NSBBs significantly increased the risk of developing renal dysfunction (OR = 1.49; p = 0.03), and this association remained significant in subgroup analyses of studies where the proportions of ascites was >70% and Child-Pugh class B/C was 100%. Based on adjusted data with propensity score matching (adjusted OR = 0.61; p = 0.08) and multivariable regression modelling (adjusted HR = 0.86; p = 0.713), NSBBs did not increase the risk of developing renal dysfunction, and this association remained not significant in subgroup analyses of studies where the proportions of ascites was >70% and <70%, the proportion of Child-Pugh class B/C was <100%, and the mean MELD score was <15. The quality of evidence was very low for all meta-analyses.

Conclusions

NSBBs may not be associated with the development of renal dysfunction in liver cirrhosis. However, more evidence is required to clarify their association in specific populations.

KEY MESSAGES

• Non-selective β blockers (NSBBs) may negatively influence renal function through decreasing heart rate and cardiac output in liver cirrhosis.

• Our meta-analysis failed to support the association of NSBBs with an increased risk of developing renal dysfunction after covariate adjustment.

Keywords:

• Nonselective β blockers
• propranolol
• acute kidney injury
• hepatorenal syndrome
• liver cirrhosis

Acknowledgments

None.

Authors’ contributions

Conception and design: Xiangbo Xu and Xingshun Qi;

Collection and assembly of data: Xiangbo Xu, Fangbo Gao, and Ting Wang;

Data analysis and interpretation: Xiangbo Xu, Fangbo Gao, Ting Wang, Zuyao Yang, and Xingshun Qi;

Manuscript writing: Xiangbo Xu, Fangbo Gao, Ting Wang, Zuyao Yang, Qingchun Zhao, and Xingshun Qi;

Final approval of manuscript: Xiangbo Xu, Fangbo Gao, Ting Wang, Zuyao Yang, Qingchun Zhao, and Xingshun Qi;

Supervision: Qingchun Zhao and Xingshun Qi.

Disclosure statement

Xiangbo Xu, Fangbo Gao, Ting Wang, Zuyao Yang, Qingchun Zhao, and Xingshun Qi declare that they have no conflict of interest.

Data availability statement

Not applicable.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.