Thiazide diuretics in advanced chronic kidney disease

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Chronic kidney disease (CKD) is prevalent in 3%-4% of the adult population in the United States, and the vast majority of these people are hypertensive. Compared with those with essential hypertension, hypertension in CKD remains poorly controlled despite the use of multiple antihypertensive drugs. Hypervolemia is thought to be a major cause of hypertension, and diuretics are useful to improve blood pressure control in CKD. Non-osmotic storage of sodium in the skin and muscle may be a novel mechanism by which sodium may modulate hypertension; further work is need to study this novel phenomenon with diuretics. Among people with stage 4 CKD, loop diuretics are recommended over thiazides. Thiazide diuretics are deemed ineffective in people with stage 4 CKD. Review of the literature suggests that thiazides may be useful even among people with advanced CKD. They cause a negative sodium balance, increasing sodium excretion by 10%-15% and weight loss by 1-2 kg in observational studies. Observational data show improvement in seated clinic blood pressure of about 10-15 mm Hg systolic and 5-10 mm Hg diastolic, whereas randomized trials show about 15 mm Hg improvement in mean arterial pressure. Volume depletion, hyponatremia, hypokalemia, hypercalcemia, and acute kidney injury are adverse effects that should be closely monitored. Our review suggests that adequately powered randomized trials are needed before the use of thiazide diuretics can be firmly recommended in those with advanced CKD.

Original languageEnglish
Pages (from-to)299-308
Number of pages10
JournalJournal of the American Society of Hypertension
Volume6
Issue number5
DOIs
StatePublished - Sep 2012

Fingerprint

Sodium Chloride Symporter Inhibitors
Chronic Renal Insufficiency
Sodium
Thiazides
Hypertension
Diuretics
Blood Pressure
Sodium Potassium Chloride Symporter Inhibitors
Hypokalemia
Hyponatremia
Hypercalcemia
Acute Kidney Injury
Antihypertensive Agents
Observational Studies
Weight Loss
Arterial Pressure
Muscles
Skin

Keywords

  • Chronic kidney disease
  • diuretics
  • hypertension
  • resistant hypertension
  • thiazides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine

Cite this

Thiazide diuretics in advanced chronic kidney disease. / Agarwal, Rajiv; Sinha, Arjun.

In: Journal of the American Society of Hypertension, Vol. 6, No. 5, 09.2012, p. 299-308.

Research output: Contribution to journalArticle

@article{505eeb57e1d0453a8adfdecfdd182a26,
title = "Thiazide diuretics in advanced chronic kidney disease",
abstract = "Chronic kidney disease (CKD) is prevalent in 3{\%}-4{\%} of the adult population in the United States, and the vast majority of these people are hypertensive. Compared with those with essential hypertension, hypertension in CKD remains poorly controlled despite the use of multiple antihypertensive drugs. Hypervolemia is thought to be a major cause of hypertension, and diuretics are useful to improve blood pressure control in CKD. Non-osmotic storage of sodium in the skin and muscle may be a novel mechanism by which sodium may modulate hypertension; further work is need to study this novel phenomenon with diuretics. Among people with stage 4 CKD, loop diuretics are recommended over thiazides. Thiazide diuretics are deemed ineffective in people with stage 4 CKD. Review of the literature suggests that thiazides may be useful even among people with advanced CKD. They cause a negative sodium balance, increasing sodium excretion by 10{\%}-15{\%} and weight loss by 1-2 kg in observational studies. Observational data show improvement in seated clinic blood pressure of about 10-15 mm Hg systolic and 5-10 mm Hg diastolic, whereas randomized trials show about 15 mm Hg improvement in mean arterial pressure. Volume depletion, hyponatremia, hypokalemia, hypercalcemia, and acute kidney injury are adverse effects that should be closely monitored. Our review suggests that adequately powered randomized trials are needed before the use of thiazide diuretics can be firmly recommended in those with advanced CKD.",
keywords = "Chronic kidney disease, diuretics, hypertension, resistant hypertension, thiazides",
author = "Rajiv Agarwal and Arjun Sinha",
year = "2012",
month = "9",
doi = "10.1016/j.jash.2012.07.004",
language = "English",
volume = "6",
pages = "299--308",
journal = "Journal of the American Society of Hypertension",
issn = "1933-1711",
publisher = "Elsevier Ireland Ltd",
number = "5",

}

TY - JOUR

T1 - Thiazide diuretics in advanced chronic kidney disease

AU - Agarwal, Rajiv

AU - Sinha, Arjun

PY - 2012/9

Y1 - 2012/9

N2 - Chronic kidney disease (CKD) is prevalent in 3%-4% of the adult population in the United States, and the vast majority of these people are hypertensive. Compared with those with essential hypertension, hypertension in CKD remains poorly controlled despite the use of multiple antihypertensive drugs. Hypervolemia is thought to be a major cause of hypertension, and diuretics are useful to improve blood pressure control in CKD. Non-osmotic storage of sodium in the skin and muscle may be a novel mechanism by which sodium may modulate hypertension; further work is need to study this novel phenomenon with diuretics. Among people with stage 4 CKD, loop diuretics are recommended over thiazides. Thiazide diuretics are deemed ineffective in people with stage 4 CKD. Review of the literature suggests that thiazides may be useful even among people with advanced CKD. They cause a negative sodium balance, increasing sodium excretion by 10%-15% and weight loss by 1-2 kg in observational studies. Observational data show improvement in seated clinic blood pressure of about 10-15 mm Hg systolic and 5-10 mm Hg diastolic, whereas randomized trials show about 15 mm Hg improvement in mean arterial pressure. Volume depletion, hyponatremia, hypokalemia, hypercalcemia, and acute kidney injury are adverse effects that should be closely monitored. Our review suggests that adequately powered randomized trials are needed before the use of thiazide diuretics can be firmly recommended in those with advanced CKD.

AB - Chronic kidney disease (CKD) is prevalent in 3%-4% of the adult population in the United States, and the vast majority of these people are hypertensive. Compared with those with essential hypertension, hypertension in CKD remains poorly controlled despite the use of multiple antihypertensive drugs. Hypervolemia is thought to be a major cause of hypertension, and diuretics are useful to improve blood pressure control in CKD. Non-osmotic storage of sodium in the skin and muscle may be a novel mechanism by which sodium may modulate hypertension; further work is need to study this novel phenomenon with diuretics. Among people with stage 4 CKD, loop diuretics are recommended over thiazides. Thiazide diuretics are deemed ineffective in people with stage 4 CKD. Review of the literature suggests that thiazides may be useful even among people with advanced CKD. They cause a negative sodium balance, increasing sodium excretion by 10%-15% and weight loss by 1-2 kg in observational studies. Observational data show improvement in seated clinic blood pressure of about 10-15 mm Hg systolic and 5-10 mm Hg diastolic, whereas randomized trials show about 15 mm Hg improvement in mean arterial pressure. Volume depletion, hyponatremia, hypokalemia, hypercalcemia, and acute kidney injury are adverse effects that should be closely monitored. Our review suggests that adequately powered randomized trials are needed before the use of thiazide diuretics can be firmly recommended in those with advanced CKD.

KW - Chronic kidney disease

KW - diuretics

KW - hypertension

KW - resistant hypertension

KW - thiazides

UR - http://www.scopus.com/inward/record.url?scp=84866420019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866420019&partnerID=8YFLogxK

U2 - 10.1016/j.jash.2012.07.004

DO - 10.1016/j.jash.2012.07.004

M3 - Article

VL - 6

SP - 299

EP - 308

JO - Journal of the American Society of Hypertension

JF - Journal of the American Society of Hypertension

SN - 1933-1711

IS - 5

ER -