Revisiting diuretic choice in chronic kidney disease

Sehrish Ali, Sankar D. Navaneethan, Salim S. Virani, L. Parker Gregg

Research output: Contribution to journalReview articlepeer-review

8 Citations (Scopus)


Purpose of reviewExisting guidelines offer little direction about the use of thiazide and loop diuretics in patients with chronic kidney disease (CKD). This review summarizes recent studies impacting indications and safety considerations for these agents in patients with CKD.Recent findingsChlorthalidone reduces blood pressure compared to placebo in patients with advanced CKD, challenging the belief that thiazide diuretics lose efficacy at lower glomerular filtration rates (GFR). Existing studies show no clear impact of thiazide or loop diuretic use on kidney or cardiovascular outcomes in patients with CKD. Sodium-glucose co-transporter type 2 (SGLT2) inhibitors have diuretic effects, but concomitant use of a diuretic does not diminish the preventive benefits of these agents against acute kidney injury (AKI). Despite theoretical concerns, thiazide diuretics likely do not worsen circulating vasopressin levels or cyst progression in polycystic kidney disease and may be useful for alleviating polyuria from tolvaptan. Diuretics cause multiple adverse effects, including electrolyte abnormalities, hemodynamic-mediated decrease in estimated GFR, and AKI.SummaryRecent evidence supports expanded indications for diuretics in patients with kidney disease, including chlorthalidone for hypertension in advanced CKD. Monitoring electrolytes and estimated GFR is critical to ensure patient safety when prescribing these agents for patients with CKD.

Original languageEnglish
Pages (from-to)406-413
Number of pages8
JournalCurrent Opinion in Nephrology and Hypertension
Issue number5
Publication statusPublished - 1 Sept 2022
Externally publishedYes


  • chronic kidney disease
  • hypertension
  • loop diuretics
  • sodium-glucose co-transporter type 2 inhibitors
  • thiazide diuretics


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