{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:28:01Z","timestamp":1790141281506,"version":"4.0.1"},"reference-count":76,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,24]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Sodium and volume excess is the fundamental risk factor underlying hypertension in chronic kidney disease (CKD) patients, who represent the prototypical population characterized by salt-sensitive hypertension. Low salt diets and diuretics constitute the centrepiece for blood pressure control in CKD. In patients with CKD stage 4, loop diuretics are generally preferred to thiazides. Furthermore, thiazide diuretics have long been held as being of limited efficacy in this population. In this review, by systematically appraising published randomized trials of thiazides in CKD, we show that this class of drugs may be useful even among people with advanced CKD. Thiazides cause a negative sodium balance and reduce body fluids by 1\u20132\u00a0l within the first 2\u20134\u00a0weeks and these effects go along with improvement in hypertension control. The recent CLICK trial has documented the antihypertensive efficacy of chlorthalidone, a long-acting thiazide-like diuretic, in stage 4 CKD patients with poorly controlled hypertension. Overall, chlorthalidone use could be considered in patients with treatment-resistant hypertension when spironolactone cannot be administered or must be withdrawn due to side effects. Hyponatremia, hypokalaemia, volume depletion and acute kidney injury are side effects that demand a vigilant attitude by physicians prescribing these drugs. Well-powered randomized trials assessing hard outcomes are still necessary to more confidently recommend the use of these drugs in advanced CKD.<\/jats:p>","DOI":"10.1093\/ckj\/sfac198","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T15:01:28Z","timestamp":1662562888000},"page":"41-51","source":"Crossref","is-referenced-by-count":16,"title":["Thiazide diuretics are back in CKD: the case of chlorthalidone"],"prefix":"10.1093","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-2089","authenticated-orcid":false,"given":"Roberto","family":"Minutolo","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania \u201cLuigi Vanvitelli\u201d Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8532-0182","authenticated-orcid":false,"given":"Luca","family":"De Nicola","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania \u201cLuigi Vanvitelli\u201d Naples , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mallamaci","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa di Nefrologia, Dialisi e Trapianto Renale, Grande Ospedale Metropolitano di Reggio Calabria , Rome , Italy"},{"name":"Institute of Clinical Physiology-Reggio Calabria Unit, National Research Council of Italy , Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6616-1996","authenticated-orcid":false,"given":"Carmine","family":"Zoccali","sequence":"additional","affiliation":[{"name":"Renal Research Institute , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"2023012409562204400_bib1","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1038\/sj.ki.5000085","article-title":"Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention","volume":"69","author":"De Nicola","year":"2006","journal-title":"Kidney Int"},{"key":"2023012409562204400_bib2","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1681\/ASN.V1161100","article-title":"Urinary protein binding does not affect response to furosemide in patients with nephrotic syndrome","volume":"11","author":"Agarwal","year":"2000","journal-title":"J Am Soc Nephrol"},{"key":"2023012409562204400_bib3","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1056\/NEJMoa2110730","article-title":"Chlorthalidone for hypertension in advanced chronic kidney 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