Beta-blockers can improve clinical outcomes in patients with coronary artery disease or heart failure and reduced ejection fraction, and they are effective even in treating patients with chronic kidney disease (CKD). 1 Betablockers are used to treat 60-75% of patients with CKD and heart failure; however, it is necessary to carefully monitor for adverse events in these patients. 2 Atenolol, a beta-blocker, is eliminated mainly via the kidneys, with 94% of an intravenous dose excreted in the urine; therefore, dose reductions are generally recommended for patients with CKD. 3 However, dose reductions of other beta-blockers, such as metoprolol, are not generally recommended even in patients with CKD.