title: Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  The Cockcroft-Gault formula normalized for body surface-area was used to estimate renal function (eGFR(BSA)) in 2622 patients with HF, left ventricular ejection fraction < or =35%, New York Heart Association class III/IV and serum creatinine <300 micromol/L (3.4 mg/dL) in the second Cardiac Insufficiency Bisoprolol Study II. Patients were divided into four sub-groups according to baseline eGFR(BSA) (<45, 45-60, 60-75 and > or =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 eGFR(BSA) sub-groups. Older age, female-sex, diabetes and ischaemic-aetiology were more common in those with reduced eGFR(BSA). 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 eGFR(BSA) 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 eGFR(BSA) < 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.
  
  
  CONCLUSIONS
  The beneficial effects of bisoprolol on mortality and hospitalization for worsening heart-failure were not modified by baseline eGFR(BSA). Renal impairment should not prevent the use of bisoprolol in patients with HF.
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Turin, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: James D
authors.initials: JD
authors.lastname: Lewsey
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Remme
authors.forename: José L
authors.initials: JL
authors.lastname: Lopez-Sendon
authors.forename: Philippe
authors.initials: P
authors.lastname: Lechat
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
authors.forename: Christer
authors.initials: C
authors.lastname: Höglund
authors.forename: Viacheslav
authors.initials: V
authors.lastname: Mareev
authors.forename: Zygmunt
authors.initials: Z
authors.lastname: Sadowski
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Seabra-Gomes
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Dargie
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D017298:Bisoprolol