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Thiazides in chronic kidney disease: "back to the future"
Rafael de la Espriella1, Marta Cobo2,3, Julio Núñez1,3,4
1Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Clinical Kidney Journal
|February 2, 2023
Summary
Thiazide diuretics are effective for hypertension management. Recent reviews suggest they are safe and effective even in advanced chronic kidney disease (CKD), challenging previous reluctance.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Thiazide diuretics are primary treatments for hypertension, used alone or combined with other drugs.
- Despite over 60 years of use, their application in advanced chronic kidney disease (CKD) is limited due to safety and efficacy concerns.
- An updated review examines thiazide diuretics' pharmacology, efficacy, and safety in CKD patients.
Discussion:
- Concerns about reduced efficacy and potential adverse effects of thiazides in advanced CKD are prevalent.
- Evidence suggests that thiazides maintain antihypertensive efficacy and a favorable safety profile even with declining kidney function.
- The review analyzes randomized controlled trials evaluating thiazides specifically in CKD populations.
Key Insights:
- Thiazide diuretics remain effective antihypertensive agents across various stages of chronic kidney disease.
- The efficacy and safety of thiazides in advanced CKD are supported by current evidence, countering historical hesitancy.
- This review provides a comprehensive assessment of thiazide use in CKD, integrating pharmacological data and clinical trial results.
Outlook:
- Further research may solidify the role of thiazides as a cornerstone therapy for hypertension in all CKD stages.
- Clinical guidelines may be updated to reflect the demonstrated safety and efficacy of thiazides in advanced CKD.
- Increased confidence in using thiazides could improve hypertension management outcomes for patients with kidney disease.
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