Non-selective beta-blocker treatment does not impact on kidney function in patients on primary and secondary prophylaxis of variceal bleeding

Background: Non-selective beta-blocker (NSBB) treatment is used for bleeding prophylaxis in cirrhotic patients with gastroesophageal varices (GEVs). Recent data suggested that NSBB treatment might increase the risk of renal dysfunction in subgroups of patients with refractory ascites due to impaired adrenergic/sympathomimetic compensation of the circulatory reserve.

Methods: Retrospective longitudinal assessment of kidney function in a cohort of cirrhotic patients with GEVs with versus without NSBB therapy. Serum creatinine, the incidence of acute kidney injury (AKI), new onset of large volume ascites, and TIPS/transplant-free survival was compared.

Results: Among 176 patients, 93 patients received NSBB while 83 were non-NSBB users. Most patients were male (77.8%), had alcoholic or viral etiology, and mean age and BMI was 53.4 years and 26.3 kg/m2, respectively. Over a 3-year follow-up, renal function – as assessed by serum creatinine every 3 months – was comparable between patients with and without NSBB treatment (p = n.s. for each timepoint). Similarly, estimated incidence of AKI was equal in NSBB vs. non-NSBB patients (p = 0.323). Patients on NSBB treatment showed a significantly better TIPS/transplant-free survival than non-NSBB patients (p = 0.041). Even in potential risk groups (patients with ascites, MAP< 90 mmHg, pre-existing renal impairment as defined by baseline creatinine> 1.2 mg/dL, and hyponatremia with Na< 135mmol/L) there was no consistent difference in serum creatinine during follow-up (p = n.s. for 68/72 timepoints). While presence of ascites (OR: 3.901, 95% CI: 1.352 – 11.251, p = 0.012) and pre-existing renal impairment (OR: 4.315, 95% CI: 1.054 – 17.672, p = 0.042) were independently associated with increased risk of AKI, only NSBB-use (OR: 0.358, 95% CI: 0.137 – 0.938, p = 0.037) was associated with improved TIPS/transplant-free survival.

Conclusion: In unselected cirrhotic patients requiring primary or secondary prophylaxis of variceal bleeding – including patients with ascites, hypotension, hyponatremia, and pre-existing renal impairment – NSBB treatment was neither associated with worsening of kidney function nor with an increased risk of AKI. On the contrary, NSBB treatment appears to improve TIPS/transplant-free survival.