**Beta Blocker Dialyzability on Cardiovascular Outcomes Study** This study is for veterans with end-stage kidney disease (ESKD) who are on a treatment called hemodialysis. Hemodialysis is a process that cleans your blood when your kidneys can't. The goal is to see if the medication metoprolol succinate helps the heart more than carvedilol in these patients. Both drugs are beta blockers, which help your heart by slowing it down and reducing its workload. Metoprolol can be removed from the body during dialysis, while carvedilol cannot. The study will check if metoprolol improves heart health and survival better than carvedilol. **Key Points:** - **Eligibility:** You must be on hemodialysis and using one of several beta blockers, like metoprolol or carvedilol. - **Exclusions:** You can't join if you have decision-making issues, asthma (not on carvedilol), or an allergy to the drugs. - **Participation:** Your doctor must agree to prescribe the study medication, and consent must be given directly by you, not a surrogate.