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

Background. Loop diuretics are the drugs of choice for the treatment of hypertension in chronic renal failure patients. However, the adaptive changes in the distal nephron and the short half-life of these drugs may decrease their long-term efficacy. Thiazides are not believed to be efficient in adva...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2005-02, Vol.20 (2), p.349-353
Main Authors: Dussol, Bertrand, Moussi-Frances, Julie, Morange, Sophie, Somma-Delpero, Claude, Mundler, Olivier, Berland, Yvon
Format: Article
Language:English
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Summary:Background. Loop diuretics are the drugs of choice for the treatment of hypertension in chronic renal failure patients. However, the adaptive changes in the distal nephron and the short half-life of these drugs may decrease their long-term efficacy. Thiazides are not believed to be efficient in advanced renal failure, but this is debated. Methods. We compared the efficacy of long-acting furosemide (60 mg/day) and hydrochlorothiazide (25 mg/day) in a double-blind, randomized crossover trial in seven patients with severe renal failure and hypertension (seven men, 54±10 years old). The primary end-points were sodium and chloride fractional excretions after 1 month of each diuretic and then after their combination. During the trial, other treatments and the diet were controlled. Results. A trend towards an increase in the fractional excretion of sodium and of chloride was observed with furosemide, but the difference did not reach the level of statistical significance (P = NS). Hydrochlorothiazide significantly increased fractional excretion of sodium and chloride from 3.7±0.9 to 5.5±0.3 and from 3.9±0.19 to 6.5±0.3, respectively (P
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfh650