The Role of Thiazide Diuretics in Hypertension with Chronic Kidney Disease: Benefits and Risks
TL;DR
Thiazide diuretics remain valuable for hypertension management in CKD, but treatment should be individualized and accompanied by regular monitoring of renal function and electrolytes, and lifestyle modification should complement pharmacological therapy to optimize outcomes.
Abstract
Hypertension is a common complication of chronic kidney disease (CKD) and contributes to renal disease progression and cardiovascular risk. Although the effectiveness of thiazide diuretics in advanced CKD has been questioned, recent evidence indicates that thiazide and thiazide-like diuretics remain useful for blood pressure control. This literature review aimed to evaluate the role, benefits, and potential risks of thiazide diuretics in managing hypertension among patients with CKD. A narrative literature review was conducted using national and international journals and clinical practice guidelines published between 2021 and 2026. A total of 806 articles were identified, and 11 studies met the predefined inclusion and exclusion criteria for qualitative analysis. The findings demonstrated that thiazide and thiazide-like diuretics effectively reduced blood pressure in patients with CKD, including those with advanced disease and resistant hypertension. Chlorthalidone significantly reduced systolic blood pressure and albuminuria, indicating potential renoprotective benefits. Combination therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provided better blood pressure control than monotherapy. However, adverse effects included hypokalemia, hyponatremia, hyperuricemia, hypotension, and transient increases in serum creatinine. Thiazide diuretics remain valuable for hypertension management in CKD, but treatment should be individualized and accompanied by regular monitoring of renal function and electrolytes. Lifestyle modification should complement pharmacological therapy to optimize outcomes.