What question did this study set out to answer?

To compare the natriuretic, chloruretic, and antihypertensive efficacy of long-acting furosemide versus hydrochlorothiazide alone and in combination in patients with severe chronic renal failure.

December 22, 2004Nephrology Dialysis Transplantation

A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension

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Why the study?

Does hydrochlorothiazide improve sodium and chloride fractional excretions compared to furosemide in men with severe renal failure and hypertension?

Population

7 men with severe renal failure and hypertension, mean age 54+/-10 years old.

Comparison

Hydrochlorothiazide (25 mg/day) for 1 month vs Long-acting furosemide (60 mg/day) for 1 month

Design

RCT, randomized crossover trial, double-blind

Follow-up

1 month per treatment phase

Authors

BDB. DussolHôpital Necker-Enfants Malades JMJulie Moussi‐FrancèsHôpital Saint Joseph SMSophie MorangeAssistance Publique Hôpitaux de Marseille

Discussion

Member takes

Implication

Supports hydrochlorothiazide for natriuresis in severe renal failure; challenges the assumption that thiazides are ineffective in advanced CKD.

Key Points

To compare the natriuretic, chloruretic, and antihypertensive efficacy of long-acting furosemide versus hydrochlorothiazide alone and in combination in patients with severe chronic renal failure.
Conducted a double-blind, randomized crossover trial in seven men with severe renal failure and hypertension (mean age 54 ± 10 years).
Administered long-acting furosemide (60 mg/day) and hydrochlorothiazide (25 mg/day) for 1 month each, followed by dual combination therapy, under controlled dietary and medication conditions.
Assessed primary endpoints of fractional excretions of sodium and chloride, along with changes in mean arterial blood pressure.
Hydrochlorothiazide significantly increased fractional excretion of sodium from 3.7 ± 0.9 to 5.5 ± 0.3 and chloride from 3.9 ± 0.19 to 6.5 ± 0.3 (P < 0.05), whereas furosemide produced a non-significant trend (P = NS).
Mean arterial blood pressure decreased significantly from 112 mmHg to 97 mmHg with furosemide, 99 mmHg with hydrochlorothiazide, and 97 mmHg with combination therapy (P < 0.05 for all).
Combining furosemide with hydrochlorothiazide produced no additional increase in sodium or chloride fractional excretion beyond hydrochlorothiazide alone.

Structured PICO

Does hydrochlorothiazide improve sodium and chloride fractional excretions compared to furosemide in men with severe renal failure and hypertension?

Population

7 men with severe renal failure and hypertension, mean age 54+/-10 years old.

Intervention

Hydrochlorothiazide (25 mg/day) for 1 month

Comparator

Long-acting furosemide (60 mg/day) for 1 month

Outcome

Sodium and chloride fractional excretions after 1 month of each diuretic and then after their combinationsurrogate

Hydrochlorothiazide effectively increases sodium and chloride fractional excretion and lowers blood pressure in severe renal failure, challenging the belief that thiazides are ineffective in this population.

Cite This Study

Dussol et al. (2004) studied this question.

synapsesocial.com/papers/6a6ff1f4e5469ee92be0bd83 https://doi.org/10.1093/ndt/gfh650

Topics

Hypertension management

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Implication

Supports hydrochlorothiazide for natriuresis in severe renal failure; challenges the assumption that thiazides are ineffective in advanced CKD.

A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider