Thiazides in Chronic Kidney Disease: New Evidence Challenging Old Dogma

Authors:
Michael E. Ernst, PharmD, BCGP
Michelle A. Fravel, PharmD, BCPS

Reviewers:
Michael S. Kelly, PharmD, BCACP
Eric J. MacLaughlin, PharmD, BCPS

Citation:
Agarwal R, Sinha AD, Cramer AE, et al.  Chlorthalidone for hypertension in advanced chronic kidney disease.  N Engl J Med 2021;385:2507-19.

The Problem

Thiazide, and thiazide-like, diuretics have been in clinical use for more than 60 years, but it is uncertain whether they are effective antihypertensives in patients with advanced chronic kidney disease (CKD).  This is a group in which hypertension is difficult to control and usually requires multiple agents to achieve target blood pressures (BP).