title: Do beta-blockers combined with RAS inhibitors make sense after all to protect against renal injury?
abstract: In chronic kidney disease (CKD) sympathetic overactivity is stimulated by signals from the diseased kidney activating hypothalamic centers. In addition, breakdown of circulating catecholamines is decreased. Indications for beta-blockers are cardio- and renoprotection. Cardioprotection is important because cardiovascular (CV) death is two- to 20-fold more likely in CKD than end-stage kidney disease; consequently, beta-blockers, with their adverse effect on CV risk profile, should be avoided. Controlled prospective evidence for renoprotection by beta-blockers in nondiabetic CKD with hard end points is lacking, but renoprotection by antihypertensive agents was first documented by administering beta-blockers in patients with diabetic nephropathy. Renoprotection by beta-blockers was seen experimentally. Furthermore, controlled studies documented a beneficial effect on albuminuria as a surrogate marker for renoprotection in diabetic and nondiabetic patients. Renin-angiotensin system blockade is the undoubted first-line treatment in CKD. Several points argue for ancillary treatment with beta-blockers: in CKD often four or more different antihypertensive drugs are required and cardiac indications are frequent.
authors.affiliation: Nierenzentrum, Im Neuenheimer Feld 162,D69120 Heidelberg, Germany. prof.e.ritz@t-online.de
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Rump
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000293:injuries; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011507:Proteinuria / Q000188:drug therapy; D051381:Rats; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors