A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension

Dussol, Bertrand; Moussi-Francès, Julie; Morange, Sophie; Somma-Delpéro, Claude; Mundler, O.; Berland, Yvon

doi:10.1093/ndt/gfh650

Cited by 66 publications

(50 citation statements)

References 9 publications

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“…18 While thiazide therapy is considered generally ineffective when the GFR is <20 to 30 cc ⁄ min, 4,19 at least one randomized controlled study showed no difference in antihypertensive efficacy comparing HCTZ 25 mg with long-acting furosemide 60 mg in patients with stage 4 or 5 chronic kidney disease. 16 Probably the dose of furosemide was too low in this trial of 7 patients with GFRs ranging from 12 cc ⁄ min to 41 cc⁄ min. Therefore, there is fair evidence, based on the unanimous conclusions of six small prospective randomized trials, to recommend HCTZ 50 mg or chlorthalidone 25 mg rather than furosemide to treat resistant hypertension when the GFR is >50 cc ⁄ min due to improved efficacy (Table I).…”

mentioning

confidence: 79%

Resistant Hypertension Responding to Change From Furosemide to Thiazide: Understanding Calcium Channel Blocker–Related Edema

Handler

2010

J of Clinical Hypertension

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A 73-year-old man was referred to a hypertension clinic for hypertension resistant to three drugs, including a diuretic. Two years previously, hydrochlorothiazide (HCTZ) 25 mg increased to 50 mg was initiated and then followed by amlodipine 5 mg, then 10 mg daily. Due to the development of dependent peripheral edema, HCTZ was changed to furosemide 20 mg twice a day, then 40 mg twice a day. According to the patient, there was no appreciable change in the edema. Metoprolol 50 mg twice a day and losartan 50 mg daily were added prior to referral.At the time of the hypertension clinic evaluation, the patient's blood pressures (BPs) were 146 ⁄ 82 mm Hg and 144 ⁄ 84 mm Hg and physical examination was remarkable for 1+ bilateral ankle and bipedal edema. Serum creatinine was 1.2 mg ⁄ dL (normal 0.6-1.2 mg ⁄ dL) with an estimated glomerular filtration rate (GMR) of 56 cc ⁄ min (normal >90 cc ⁄ min). Furosemide was changed to chlorthalidone 25 mg daily with unchanged mild edema, and follow-up BPs were 134 ⁄ 80 mm Hg and 132 ⁄ 82 mm Hg. The patient was assured that his mild edema was not medically detrimental, and daytime compression stockings and leg elevation were advised as needed. DISCUSSION Hypertension Clinic Experience With Thiazide and FurosemideThe common experience of two university referral clinics for resistant hypertension has been that a chance to select a diuretic appropriate for renal function can occasionally lead to control.

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confidence: 79%

Resistant Hypertension Responding to Change From Furosemide to Thiazide: Understanding Calcium Channel Blocker–Related Edema

Handler

2010

J of Clinical Hypertension

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“…Importantly, 5 randomized controlled trials (RCT) reported between 1979 and 2012 have investigated thiazide efficacy in CKD [30][31][32][33][34], also detailed in Table 1. The earliest was a double blind crossover study that enrolled 16 woman with mean creatinine clearance of 14 mL/min/1.73 m 2 who were treated with chlorothiazide 500 mg twice daily or placebo for 6 weeks before crossover [30].…”

Section: Older Studies Of Thiazides In Ckdmentioning

confidence: 99%

“…After washout they then crossed over to the other drug. Finally, they received 30 day period of combination therapy [33]. The second RCT was reported in 2012 and enrolled 23 subjects with measured GFR of 25 mL/min [34].…”

Section: Older Studies Of Thiazides In Ckdmentioning

confidence: 99%

Thiazides in advanced chronic kidney disease

Sinha

Agarwal

2015

Current Opinion in Cardiology

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Running title: thiazides in CKD Word count for abstract : 191 Word count for the text: 2351 ABSTRACTPurpose of the review: Chronic kidney disease is common, associated with increased cardiovascular risk, and frequently complicated by hypertension requiring multiple agents for control. Thiazides are naturally attractive for use in this population, unfortunately they are classically thought to be ineffective in advanced chronic kidney disease based on both theoretical considerations and the earliest studies of these agents. This report reviews the studies of thiazide use in chronic kidney disease since the 1970s, including 5 randomized controlled trials, all of which report at least some degree of efficacy.Recent findings: Two recent studies add further evidence for the utility and efficacy of thiazides in chronic kidney disease. Of these two, one uses gold standard ambulatory blood pressure monitoring in patients with poorly controlled hypertension and advanced chronic kidney disease and found chlorthalidone reduces blood pressure. The second is the largest study to date of thiazides in chronic kidney disease; adding a fixed low-dose chlorthalidone as the first diuretic to the antihypertensive regimen improved blood pressure.Summary: These numerous small but positive studies reinforce the need for a randomized trial to demonstrate safety and efficacy of thiazides in advanced chronic kidney disease.

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“…Drug-induced diuresis is beneficial in many life threatening disease conditions such as cardiac failure, chronic and moderate cardiac insufficiencies, acute edema of the lung, nephritic edema syndrome, arterial hypertension, diseases related with the retention of fluids etc 1,2 . Ural syrup is a patent and proprietary Ayurvedic formulation which contains extract of Tribulus terrestris (Gokshur) 3 , Berginia ligulata (Pashanbhed) 4 , Boerhaavia diffusa (Punarnava) 5 , Crataeva nurvala (Varun) 6 , Raphanus sativus (Mulika) 7 , Dolichos biflorus (Kulathi) 8 , Smilax china (Chopchini) 9 and powder of Sodii carbonas (Swarjikakshar) 10 , Borax (Shuddha Tankan) 11 , Potasii carbonas (Yavakshar) 12 , Kala namak (Black Salt) 13 and Citrus acida (Nimbuk) 14 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Acute Toxicity Study and Diuretic Activity of Ural Syrup

Tejas¹,

Patel²,

Soni³

et al. 2013

Int. J. Res. Ayurveda Pharm.

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There are considerable amount of scientific evidences available for diuretic activity of individual ingredients of a polyherbal formulation Ural Syrup however no evidence has been found which proves overall safety and efficacy of the formulation. The present study was undertaken to investigate safety as well as Diuretic activity of this polyherbal formulation-Ural Syrup. Acute toxicity study was carried out as per OECD Guideline 420. The Ural syrup (1.8mL/kg and 3.6mL/kg) was tested for its diuretic activity on rat model. Hydrochlorothiazide (HCTZ) (10mg/kg) was used as positive control in study. The diuretic effect of the Ural syrup was evaluated by measuring urine volume, pH and excretion of sodium and potassium content. In result, significant increase in urine volume was observed at both dosage levels of Ural syrup in comparison to normal control group. There was no significant change observed in pH of urine. The excretion of Sodium was also found significantly increased at both dosage levels but more in TEDx2 group with respect to TED group. Potassium excretion was found increased only at TEDx2 group as compared to normal control group. It can be concluded that Ural syrup produced considerable diuretic effect which appeared to be comparable to that produced by the reference diuretic HCTZ. There was no lethality and toxic reaction found among the tested animals. The present study provides scientific support that Ural syrup can be employed as a safe and effective diuretic drug.

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A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension

Cited by 66 publications

References 9 publications

Resistant Hypertension Responding to Change From Furosemide to Thiazide: Understanding Calcium Channel Blocker–Related Edema

Resistant Hypertension Responding to Change From Furosemide to Thiazide: Understanding Calcium Channel Blocker–Related Edema

Thiazides in advanced chronic kidney disease

Evaluation of Acute Toxicity Study and Diuretic Activity of Ural Syrup

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