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Diuretics in patients with chronic kidney disease
Rajiv Agarwal1, Ashish Verma2, Panagiotis I Georgianos3
1Division of Nephrology, Department of Medicine, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA. ragarwal@iu.edu.
Nature Reviews. Nephrology
|January 8, 2025
Summary
Diuretic drugs manage fluid balance in chronic kidney disease (CKD) by targeting kidney transporters. They help reduce sodium and volume overload, improving blood pressure and electrolyte levels in CKD patients.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Chronic kidney disease (CKD) impairs sodium excretion due to nephron loss and renin-angiotensin-aldosterone-system activation.
- Sodium retention in CKD increases plasma volume, potentially leading to hypertension.
- Diuretics are essential for managing fluid overload and hypertension in CKD patients.
Purpose of the Study:
- To review the role of diuretic drugs in managing chronic kidney disease.
- To discuss the mechanisms of diuretic action on kidney electrolyte transporters.
- To highlight the application of diuretics in addressing sodium and volume overload, hypertension, and electrolyte imbalances in CKD.
Main Methods:
- Review of diuretic mechanisms and clinical applications in nephrology.
- Analysis of diuretic effects on renal sodium and water excretion.
- Examination of diuretic use in managing hypertension and electrolyte disorders associated with CKD.
Main Results:
- Diuretics act on kidney electrolyte transporters to promote diuresis and sodium excretion.
- Thiazide diuretics are key for hypertension, while loop diuretics address volume overload.
- Mineralocorticoid receptor antagonists are vital for resistant cases and electrolyte management.
Conclusions:
- Diuretics are fundamental in CKD management for controlling volume status and blood pressure.
- Diuretic therapy requires careful consideration of specific drug classes and patient conditions.
- Diuretics play a role in diagnosing kidney diseases and managing associated electrolyte abnormalities.
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