Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial.

Aims Information on the effectiveness of beta-blockade in patients with heart failure (HF) and concomitant renal impairment is scarce and beta-blockers are underutilized in these patients. Methods and results The Cockcroft-Gault formula normalized for body surface-area was used to estimate renal function (eGFRBSA) in 2622 patients with HF, left ventricular ejection fraction ≤35, New York Heart Association class III/IV and serum creatinine <300 mol/L (3.4 mg/dL) in the second Cardiac Insufficiency Bisoprolol Study II. Patients were divided into four sub-groups according to baseline eGFRBSA (<45, 45-60, 60-75 and ≥75 mL/min per 1.73 m 2). Cox proportional-hazards models adjusted for pre-specified confounders were used to assess the effect of bisoprolol and potential heterogeneity of effect across the eGFRBSA sub-groups. Older age, female-sex, diabetes and ischaemic-aetiology were more common in those with reduced eGFRBSA. The hazard associated with bisoprolol use for all-cause mortality, the composite of all-cause mortality or HF-hospitalization and HF-hospitalization alone was consistently <1.0 across eGFRBSA categories with no treatment by renal-function interaction (P = 0.81, P = 0.66, P = 0.71, respectively). The rate of bisoprolol discontinuation was higher in patients with eGFRBSA < 45 mL/min per 1.73 m 2. Nevertheless the absolute benefit of bisoprolol was greater for patients with chronic kidney disease compared with those without. Conclusion The beneficial effects of bisoprolol on mortality and hospitalization for worsening heart-failure were not modified by baseline eGFRBSA. Renal impairment should not prevent the use of bisoprolol in patients with HF.