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.