Arq. Bras. Cardiol. 2023; 120(9): e20230115
Suspension of Thiazide Diuretics in Advanced Chronic Kidney Disease. Time to Review an Old Concept
Rodrigo Bezerra
, Flávio Teles de Farias Filho
, Audes Feitosa
, Wilson Nadruz
, Andrea Araújo Brandão
, Weimar Kunz Sebba Barroso
The Hypertension Guidelines of the Sociedade Brasileira de Cardiologia (SBC), Brazilian Society of Hypertension (BSH), and Brazilian Society of Nephrology (BSN) recommend the use of loop diuretics to replace thiazides in patients with chronic kidney disease (CKD) stages 4 and 5, who have glomerular filtration rate (GFR) ≤ 30ml/min/1.73m2.
These guidelines are in line with other guidelines, such as the European Hypertension Guideline (ESC/ESH 2018), which states that thiazide and thiazide-like diuretics are less effective in patients with GFR < 45ml/min/1.73m2 and ineffective when GFR < 30ml/min/1.73m2. However, the study that established this concept dates from 1961 and evaluated only 11 patients, among whom 5 had GFR < 37ml/min/1.73m2. Despite this, this concept generated a dogma exported to textbooks, which has been propagated for decades as an incontestable truth.
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