A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Authors

  • Bertrand Dussol MD, PhD,

    1. From the Aix-Marseille Université, Marseille, France;
    2. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Conception, Centre de Néphrologie et de Transplantation rénale, Marseille, France;
    3. Assistance Publique – Hôpitaux de Marseille, Centre d’Investigation Clinique, Marseille, France;
    Search for more papers by this author
  • Julie Moussi-Frances MD,

    1. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Conception, Centre de Néphrologie et de Transplantation rénale, Marseille, France;
    Search for more papers by this author
  • Sophie Morange MD,

    1. Assistance Publique – Hôpitaux de Marseille, Centre d’Investigation Clinique, Marseille, France;
    Search for more papers by this author
  • Claude Somma-Delpero MD, PhD,

    1. From the Aix-Marseille Université, Marseille, France;
    2. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Nucléaire, Marseille, France
    Search for more papers by this author
  • Olivier Mundler MD,

    1. From the Aix-Marseille Université, Marseille, France;
    2. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Nucléaire, Marseille, France
    Search for more papers by this author
  • Yvon Berland MD

    1. From the Aix-Marseille Université, Marseille, France;
    2. Assistance Publique – Hôpitaux de Marseille, Hôpital de la Conception, Centre de Néphrologie et de Transplantation rénale, Marseille, France;
    3. Assistance Publique – Hôpitaux de Marseille, Centre d’Investigation Clinique, Marseille, France;
    Search for more papers by this author

Professeur Bertrand Dussol, Centre de Néphrologie et de Transplantation rénale, Hôpital de la Conception, 147 Bd Baille, 13385 Marseille Cedex 5, France
E-mail:bertrand.dussol@ap-hm.fr

Abstract

Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double-blind, cross-over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long-acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.

Ancillary