Calcium Channel Blockers are Safe and Beneficial in Patients with Heart Failure and Advanced Chronic Kidney Disease

BACKGROUND Heart failure and advanced chronic kidney disease frequently coexist and are associated with high mortality and limited therapeutic options. Calcium channel blockers (CCBs) are commonly used for blood pressure control in this population. However, their effect on survival in patients with heart failure and advanced chronic kidney disease is uncertain. We evaluated the association between CCBs use and all-cause mortality in patients with heart failure and advanced chronic kidney disease. METHODS This retrospective cohort study included 1,835 consecutive patients with heart failure and advanced chronic kidney disease (GFR ≤30 mL/min/1.73 m²) treated between January 2014 and October 2025 at a national tertiary referral center. Patients were stratified by baseline CCBs use. The primary outcome was all-cause mortality, obtained from a national registry. Multivariable Cox regression and inverse probability treatment weighting (IPTW) were used to adjust for confounders. Subgroup analyses were performed across heart failure phenotypes and key comorbidities. RESULTS Of the cohort, 988 (53.8%) received CCBs therapy (45% dihydropyridine). Over a median follow-up of 1.68 years, 69.7% of patients died. CCBs use was associated with lower mortality in unadjusted (HR 0.83, 95% CI 0.74-0.93; p=0.001) and IPTW-adjusted analyses (HR 0.85, 95% CI 0.73-0.99; p=0.038). Findings were consistent across heart failure phenotypes, diabetes, and hypertension subgroups. In subclass analyses, non-dihydropyridine CCBs were associated with a significant reduction in mortality, whereas the association with dihydropyridine agents did not reach statistical significance. CONCLUSION In patients with heart failure and advanced chronic kidney disease, CCBs use was associated with improved survival, supporting their potential role as a safe adjunctive therapy for blood pressure control in this high-risk population.