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Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis.

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  • معلومة اضافية
    • المصدر:
      Publisher: Informa Healthcare Country of Publication: England NLM ID: 8701128 Publication Model: Print Cited Medium: Internet ISSN: 1525-6049 (Electronic) Linking ISSN: 0886022X NLM ISO Abbreviation: Ren Fail Subsets: MEDLINE
    • بيانات النشر:
      Publication: London : Informa Healthcare
      Original Publication: New York, N.Y. : M. Dekker, c1987-
    • الموضوع:
      Hypertension*/drug therapy ; Renal Insufficiency, Chronic*/complications ; Renal Insufficiency, Chronic*/drug therapy; Humans ; Diuretics/pharmacology ; Diuretics/therapeutic use ; Thiazides/therapeutic use ; Thiazides/pharmacology ; Prospective Studies ; Antihypertensive Agents/therapeutic use ; Blood Pressure
    • نبذة مختصرة :
      Background and Objective: Thiazide diuretics are first-line drugs for the treatment of hypertension, but hypertension treatment guidelines have systematically discouraged their use in patients with advanced chronic kidney disease (CKD). For the first time, a systematic review and random-effects meta-analysis were performed to assess the effectiveness of thiazides and thiazide-like diuretics to treat hypertension in patients with stages 3b, 4, and 5 CKD.
      Design, Setting, Participants, & Measurements: A systematic review and random-effects meta-analysis that included a literature search using the following databases were performed: MEDLINE through PubMed, Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) through the Cochrane Library, Embase, and ISI - Web of Science (all databases). Prospective studies that evaluated the effectiveness of thiazide and thiazide-like diuretics in individuals with a GFR < 45 mL/min/1.73 m 2 were included.
      Results: Five clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m 2 to 26.8 ± 8.8 mL/min/1.73 m 2 . There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion.
      Conclusion: Thiazide and thiazide-like diuretics seem to maintain their effectiveness in lowering blood pressure in patients with advanced chronic kidney disease. These findings should spur new prospective randomized trials and spark discussions, particularly about upcoming hypertension guidelines.
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    • Contributed Indexing:
      Keywords: thiazides; Chronic kidney disease; diuretics; hypertension
    • الرقم المعرف:
      0 (Diuretics)
      0 (Thiazides)
      0 (Antihypertensive Agents)
    • الموضوع:
      Date Created: 20230113 Date Completed: 20230116 Latest Revision: 20230120
    • الموضوع:
      20231215
    • الرقم المعرف:
      PMC9848247
    • الرقم المعرف:
      10.1080/0886022X.2022.2163903
    • الرقم المعرف:
      36637019