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Optimizing Nephron Performance: The Old, the New, and the New-Old Diuretic Therapies

Flavio D Fuchs1,2, Guilherme S Procianoy1, Leonardo G Bottino1,2

  • 1Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil.

Biomedicines
|June 26, 2025
PubMed

Insights

Diuretics, both old and new, effectively manage hypertension, heart failure, and chronic kidney disease (CKD). Recent evidence highlights the efficacy of older agents like chlorthalidone and acetazolamide, alongside newer drugs such as gliflozins.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Pharmacological interventions targeting nephron function significantly impact hypertension, heart failure, and chronic kidney disease (CKD).
  • Diuretics represent a cornerstone therapy, with ongoing research exploring both established and novel agents.

Purpose of the Study:

  • To review the efficacy of traditional and newer diuretics in managing hypertension, heart failure, and CKD.
  • To highlight emerging evidence on the effectiveness of established diuretic agents.

Main Methods:

  • Review of existing literature, including randomized controlled trials and nonrandomized studies.
  • Analysis of data on thiazide, loop, potassium-sparing diuretics, indapamide, gliflozins, chlorthalidone, and acetazolamide.

Main Results:

  • Established diuretics (thiazides, loop diuretics) show efficacy in heart failure and CKD, with randomized trials confirming their role in preventing cardiovascular disease.
  • Potassium-sparing agents mitigate thiazide side effects and reduce cardiovascular events in heart failure.
  • Newer agents like gliflozins offer novel mechanisms for managing heart failure and slowing CKD progression, irrespective of diabetes status.
  • Recent studies demonstrate significant blood pressure reduction with chlorthalidone in advanced CKD and accelerated clinical control with acetazolamide in acute heart failure.

Conclusions:

  • Both established and novel diuretics play crucial roles in managing cardiovascular and kidney diseases.
  • Emerging evidence reinforces the value of older diuretic agents, while newer drugs offer distinct therapeutic advantages.
  • Future research should explore combination therapies to optimize nephron function and patient outcomes.

Keywords:
blood pressurechronic kidney diseasediureticsheart failurehypertensionnephrons

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