A pilot study comparing furosemide and hydrochlorothiazide in patients with hypertension and stage 4 or 5 chronic kidney disease

Abstract

Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double-blind, cross-over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long-acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.

© 2011 Wiley Periodicals, Inc.

Figures

Figure FIGURE

Scheme of the study. The study was double‐blinded until day 240 (D240) and then opened from D240 until day 330 (D330). After a run‐in period of 2 months (from day 60 [D60] to day 0 [D0]), patients were randomized to receive either long‐acting furosemide (FUR) (60 mg) or hydrochlorothiazide (HCTZ) (25 mg) for 3 months (until day 90 [D90]). After a 1‐month washout (day 120 [D120]), patients received the other diuretic for 3 months (until day 210 [D210]). After a second washout period of 1 month (D240), patients received the combined regimen (both diuretics) for 3 months (D330). The fractional excretions of sodium and chloride and the renal parameters were determined at D0, D90, D210, and D330.