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Should diuretics always be included as initial antihypertensive management in early-stage CKD?

Julian Segura1, Luis M Ruilope

  • 1Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid 28041, Spain.

Current Opinion in Nephrology and Hypertension
|June 30, 2009
PubMed

Insights

Combined antihypertensive therapy, including diuretics, is essential for managing hypertension in chronic kidney disease (CKD) patients. Diuretics effectively control volume overload and aid in achieving blood pressure goals for renal protection.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) presents significant cardiovascular risks, including hypertension driven by volume overload.
  • Patients with CKD often exhibit micro/macroalbuminuria and multiple traditional and non-traditional risk factors.
  • Hypertension in CKD is frequently multifactorial, necessitating comprehensive management strategies.

Purpose of the Study:

  • To review the necessity of combined antihypertensive drug therapy in patients with CKD.
  • To highlight the specific role and relevance of diuretics in managing hypertension in CKD.
  • To emphasize the importance of achieving blood pressure goals for renal protection.

Main Methods:

  • Literature review focusing on antihypertensive therapy in chronic kidney disease.
  • Analysis of the role of diuretics in managing volume overload and hypertension.
  • Evaluation of evidence supporting combined therapy for blood pressure control and proteinuria reduction.

Main Results:

  • Combined antihypertensive therapy, frequently including diuretics, is typically required to reach blood pressure targets in CKD patients.
  • Volume overload and extracellular volume expansion are key contributors to hypertension in CKD.
  • Diuretics are instrumental in managing volume overload and achieving strict blood pressure control.

Conclusions:

  • Strict blood pressure control and reduction of proteinuria are crucial for protecting against CKD progression.
  • Diuretics remain a valuable tool for managing volume overload and achieving blood pressure goals in CKD.
  • Despite other agents offering independent benefits, diuretics will continue to be a cornerstone of antihypertensive treatment in CKD.
Abstract

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