Thiazides in advanced chronic kidney disease: Time for a randomized controlled trial

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose of review Chronic kidney disease is common, associated with increased cardiovascular risk, and frequently complicated by hypertension, requiring multiple agents for control. Thiazides are naturally attractive for use in this population; unfortunately, they are classically thought to be ineffective in advanced chronic kidney disease based on both theoretical considerations and the earliest studies of these agents. This report reviews the studies of thiazide use in chronic kidney disease since the 1970s, including five randomized controlled trials, all of which report at least some degree of efficacy. Recent findings Two recent studies add further evidence for the utility and efficacy of thiazides in chronic kidney disease. Of these two, one used gold standard ambulatory blood pressure monitoring in patients with poorly controlled hypertension and advanced chronic kidney disease and found chlorthalidone reduces blood pressure. The second is the largest study to date of thiazides in chronic kidney disease; adding a fixed low-dose chlorthalidone as the first diuretic to the antihypertensive regimen improved blood pressure. Summary These numerous small but positive studies reinforce the need for a randomized trial to demonstrate safety and efficacy of thiazides in advanced chronic kidney disease.

Original languageEnglish
Pages (from-to)366-372
Number of pages7
JournalCurrent Opinion in Cardiology
Volume30
Issue number4
DOIs
StatePublished - Aug 24 2015

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Thiazides
Chronic Renal Insufficiency
Randomized Controlled Trials
Chlorthalidone
Blood Pressure
Hypertension
Ambulatory Blood Pressure Monitoring
Diuretics
Antihypertensive Agents
Safety

Keywords

  • Chlorthalidone
  • Chronic kidney disease
  • Hypertension
  • Thiazide diuretics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thiazides in advanced chronic kidney disease : Time for a randomized controlled trial. / Sinha, Arjun; Agarwal, Rajiv.

In: Current Opinion in Cardiology, Vol. 30, No. 4, 24.08.2015, p. 366-372.

Research output: Contribution to journalArticle

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