School of Medicine, Federal University of Alagoas (UFAL), Maceió, Brazil.
School of Medicine, State University of Health Sciences of Alagoas (UNCISAL), Maceió, Brazil.
Ren Fail. 2023 Dec;45(1):2163903. doi: 10.1080/0886022X.2022.2163903.
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 were included.
Five clinical trials, totaling 214 participants, were included, and the mean GFR ranged from 13.0 ± 5.9 mL/min/1.73 m to 26.8 ± 8.8 mL/min/1.73 m. There was evidence of a reduction in mean blood pressure and in GFR, as well as in fractional sodium excretion and fractional chloride excretion.
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.
噻嗪类利尿剂是治疗高血压的一线药物，但高血压治疗指南系统地劝阻在晚期慢性肾脏病（CKD）患者中使用它们。首次进行了系统评价和随机效应荟萃分析，以评估噻嗪类和噻嗪样利尿剂在 3b、4 和 5 期 CKD 患者中治疗高血压的疗效。
设计、设置、参与者和测量：进行了系统评价和随机效应荟萃分析，包括使用以下数据库进行文献检索：MEDLINE 通过 PubMed、Cochrane 系统评价数据库（CDSR）和 Cochrane 中央对照试验注册中心（CENTRAL）通过 Cochrane 图书馆、Embase 和 ISI - Web of Science（所有数据库）。纳入了评估 GFR<45 mL/min/1.73 m 的个体中噻嗪类和噻嗪样利尿剂有效性的前瞻性研究。
共纳入 5 项临床试验，总计 214 名参与者，平均 GFR 范围为 13.0 ± 5.9 mL/min/1.73 m 至 26.8 ± 8.8 mL/min/1.73 m。有证据表明血压均值、GFR 以及钠和氯的排泄分数降低。
噻嗪类和噻嗪样利尿剂似乎在降低晚期慢性肾脏病患者血压方面保持其有效性。这些发现应激发新的前瞻性随机试验和讨论，特别是关于即将出台的高血压指南。
