Hypertension can either be the cause or the effect of chronic kidney disease (CKD). In either case, controlling hypertension is essential to slow down the disease progression and reduce CVD risk. Distal diuretics are a potential therapy for reducing hypertension in CKD, but evidence suggesting their effectiveness is limited. This study aims to evaluate the efficacy of distal diuretics for hypertension in CKD and comparing it with dietary sodium restriction. 

This randomized, open-label crossover trial included a total of 26 patients with CKD stage G3 or G4 and hypertension. The study compared amiloride/hydrochlorothiazide (5 mg/50 mg daily) with dietary sodium restriction (60 mmol per day). The primary outcomes were the effects on blood pressure, kidney function, and fluid balance.

The findings suggested that dietary sodium restriction reduced sodium excretion from 160 to 64 mmol per day. Distal diuretics led to a 24-hour systolic BP reduction from 138 to 124 mm Hg, compared with 134 to 129 mm Hg, in the case of dietary sodium reduction. Diuretics also produced a greater effect on eGFR, plasma renin, extracellular water, and aldosterone.

The research concluded that distal diuretics are non-inferior to dietary sodium reduction in reducing BP and improving kidney function.

Ref: https://jasn.asnjournals.org/content/31/3/650