Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, beta-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of beta-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of beta-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between beta-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54-0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29-0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31-0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48-0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80-0.92) between beta-blockers and no beta-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57-1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50-1.26). Conclusions: beta-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. (C) 2019 S. Karger AG, Basel