Should diuretics always be included as initial antihypertensive management in early-stage CKD?

Curr Opin Nephrol Hypertens. 2009 Sep;18(5):392-6. doi: 10.1097/MNH.0b013e32832eb7fb.


Purpose of review: This review focuses on the need for combined antihypertensive therapy drugs in patients with chronic kidney disease and the relevance of diuretics.

Recent findings: Chronic kidney disease is a high-risk situation characterized by the presence of volume overload-related hypertension, micro/macroalbuminuria and other traditional and nontraditional risk factors. To achieve the blood pressure goal in these patients, combined antihypertensive therapy (including diuretics) is usually required.

Summary: Extracellular volume expansion is an important, if not the most important, contributing factor to hypertension seen in chronic kidney disease. Protection against progression of renal dysfunction has two main requirements: strict blood pressure control and lowering proteinuria to values as near to normal as possible. Diuretics have been a useful tool to manage volume overload and to achieve strict blood pressure control in patients with chronic kidney disease. Albeit other blood pressure-lowering agents offer additional favorable effects independently of blood pressure changes, diuretics will continue to be used in these patients.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / physiology
  • Diuretics / therapeutic use*
  • Drug Therapy, Combination
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / etiology
  • Hypertension / physiopathology
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy*
  • Kidney Failure, Chronic / physiopathology
  • Risk


  • Antihypertensive Agents
  • Diuretics