Table 3.
Effects of diuretics on risk of kidney disease progression or kidney failure in subjects with CKD
| Study | No. of subjects | Cohort | Follow-up | Renal function at baseline | Outcome measure | Results |
|---|---|---|---|---|---|---|
| Hawkins et al. [71] (2005) | Not reported |
USRDS and IMS Health database |
1980–2001 | Not reported | ESRD incidence rate |
Relationship between annual change in diuretic (predominantly, hydrochlorothiazide and furosemide) consumption and actual change in annual ESRD Incidence growth rate (r = − 0.754, P < 0.03) |
| Khan et al. [72] (2017) | 621 | A single center | 2005–2014 | eGFR 15–59 mL/min/1.73 m2 | ESRD |
More likely for CKD progression in diuretic (unspecified class) users (HR = 2.04, P = 0.01) |
| Khan et al. [73] (2017) | 312 | A single center | 1 yr | eGFR ≤ 60 mL/min/1.73 m2 | eGFR decline, progression of RRT |
Larger annual eGFR decline in diuretic (loop diuretics in 48%, hydrochlorothiazide in 27%, furosemide plus hydrochlorothiazide in 25%) user Higher incidence of RRT in diuretic user |
| ALLHAT [74] (2005) | 33,357 |
A randomized, double-blind trial |
59.0 ± 16.5 mo |
Mild reduction (60–89 mL/min/1.73 m2) and moderate-severe reduction (< 60 mL/min/1.73 m2) in GFR |
ESRD incidence, GFR decrement of ≥ 50% from baseline | No differences in the incidence of ESRD or GFR decrement between chlorthalidone and amlodipine or lisinopril in reduced GFR groups |
| Fitzpatrick et al. [75] (2022) | 47,666 |
Kaiser Permanente Northern California database |
2008–2012 | eGFR 15–59 mL/min/1.72 m2 | ESRD, a composite renal outcome including reaching an eGFR < 15 mL/min/1.73 m2, 50% reduction in eGFR from baseline and/or ESRD | No significant association with durable reductions in eGFR in incident exposure to loop or thiazide diuretics in a diverse population with CKD compared with nondiuretic users |
CKD, chronic kidney disease; USRDS, United States Renal Data System; ESRD, end-stage renal disease; eGFR, estimated glomerular filtration rate; HR, hazard ratio; RRT, renal replacement therapy; ALLHAT: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; GFR, glomerular filtration rate