# Nierfunctiestoornis en bètablokkereffectiviteit bij hartfalen

*geplaatst 2019-12-10 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.09.059 · https://hartvaat.nl/2019/12/10/nierfunctiestoornis-en-betablokkereffectiviteit-bij-hartfalen/*

Studie naar de impact van nierfunctiestoornis op de effectiviteit van bètablokkers bij hartfalen.

## English: Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure.

This study showed that beta-blockers maintain their mortality benefit in heart failure patients with moderate renal impairment, supporting continued beta-blocker therapy regardless of kidney function status.

## Abstract (original, from the publication)

BACKGROUND: Moderate and moderately severe renal impairment are common in patients with heart failure and reduced ejection fraction, but whether beta-blockers are effective is unclear, leading to underuse of life-saving therapy. OBJECTIVES: This study sought to investigate patient prognosis and the efficacy of beta-blockers according to renal function using estimated glomerular filtration rate (eGFR). METHODS: Analysis of 16,740 individual patients with left ventricular ejection fraction <50% from 10 double-blind, placebo-controlled trials was performed. The authors report all-cause mortality on an intention-to-treat basis, adjusted for baseline covariates and stratified by heart rhythm. RESULTS: Median eGFR at baseline was 63 (interquartile range: 50 to 77) ml/min/1.73 m2; 4,584 patients (27.4%) had eGFR 45 to 59 ml/min/1.73 m2, and 2,286 (13.7%) 30 to 44 ml/min/1.73 m2. Over a median follow-up of 1.3 years, eGFR was independently associated with mortality, with a 12% higher risk of death for every 10 ml/min/1.73 m2 lower eGFR (95% confidence interval [CI]: 10% to 15%; p < 0.001). In 13,861 patients in sinus rhythm, beta-blockers reduced mortality versus placebo; adjusted hazard ratio (HR): 0.73 for eGFR 45 to 59 ml/min/1.73 m2 (95% CI: 0.62 to 0.86; p < 0.001) and 0.71 for eGFR 30 to 44 ml/min/1.73 m2 (95% CI: 0.58 to 0.87; p = 0.001). The authors observed no deterioration in renal function over time in patients with moderate or moderately severe renal impairment, no difference in adverse events comparing beta-blockers with placebo, and higher mortality in patients with worsening renal function on follow-up. Due to exclusion criteria, there were insufficient patients with severe renal dysfunction (eGFR <30 ml/min/1.73 m2) to draw conclusions. In 2,879 patients with atrial fibrillation, there was no reduction in mortality with beta-blockers at any level of eGFR. CONCLUSIONS: Patients with heart failure, left ventricular ejection fraction <50% and sinus rhythm should receive beta-blocker therapy even with moderate or moderately severe renal dysfunction.

Auteurs: Dipak Kotecha, Simrat K Gill, Marcus D Flather, Jane Holmes, Milton Packer, Giuseppe Rosano, Michael Böhm, John J V McMurray, John Wikstrand, Stefan D Anker, Dirk J van Veldhuisen, Luis Manzano, Thomas G von Lueder, Alan S Rigby, Bert Andersson, John Kjekshus, Hans Wedel, Frank Ruschitzka, John G F Cleland, Kevin Damman, Josep Redon, Andrew J S Coats

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.09.059. Bijgewerkt 2026-07-03T13:27:30Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.