The use of thiazides in chronic kidney disease

Hypertension is often difficult to control in patients with chronic kidney disease. Clinicians often view thiazide and thiazide-like diuretics as being ineffective in reducing blood pressure in patients with chronic kidney disease, and prefer to use loop diuretics, especially if the estimated glomerular filtration rate (eGFR) is below 50 ml/min/1.73m(2). Recent clinical trial data indicate that thiazide and thiazide-like diuretics possess important and clinically significant antihypertension properties, that are likely independent of volume reduction, even in patients with eGFR in the 15-45 ml/min range. Thiazide and thiazide-like diuretics should be given consideration for use in the treatment of hypertension in patients with chronic kidney disease, especially if there is no clinical evidence of volume overload.