Higher cardiovascular risk observed with beta-blockers in CKD patients without prior cardiovascular disease

Chronic kidney disease (CKD) is strongly linked to cardiovascular disease (CVD) risk. Although beta-blockers (BBs) are widely used for CVD prevention, their effectiveness and safety in CKD patients without established CVD remain uncertain.

We conducted a nationwide cohort study using Korean health insurance data. CKD patients without established CVD between 2012 and 2015 were identified based on an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² on at least two occasions. BB users were defined as those prescribed BBs for ≥6 months. Primary outcomes were all-cause mortality and 4-point major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, stroke, and hospitalization for heart failure. A 1:2 propensity score matching was performed, and Cox proportional hazards models were applied. Subgroup analyses were also conducted by eGFR category and BB agents.

After matching, 9067 BB users and 17 094 non-users were included. BB use was associated with increased risks of all-cause mortality (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.96-2.24) and MACE (HR, 1.33; 95% CI, 1.26-1.41). The increased risks were consistent across individual outcomes, including cardiovascular death (HR, 2.07; 95% CI, 1.66-2.57), myocardial infarction (HR, 1.29; 95% CI, 1.13-1.46), stroke (HR, 1.21; 95% CI 1.13-1.31), and heart failure hospitalization (HR, 1.58; 95% CI, 1.44-1.72). Subgroup analysis showed greater mortality risk at lower eGFR levels and a higher risk of adverse events with carvedilol compared with other BBs.

Among CKD patients without established CVD, BB use was associated with increased mortality and cardiovascular risk. Further studies are needed to clarify whether these associations reflect treatment effects or underlying patient risk.