Thiazide and thiazide-like diuretics associated with improved cardiovascular and renal outcomes for chronic kidney disease patients

Author:

Lin Hugo1,Chang Yu-Han1,Wang Yu-Tsang2,Liang Peir-In3,Hung Chi-Chih4,Chang Jer-Ming4,Dai Dao-Fu5,Lin Chang-Shen6,Chang Kai-Ting7

Affiliation:

1. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan

2. Management Office, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

3. Department of Pathology, Kaohsiung Medical University Hospital, Taiwan

4. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan

5. Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

6. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan

7. Department of Pediatrics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan

Abstract

Taiwan Introduction: Hypervolemia is a prevalent comorbidity of chronic kidney disease (CKD) patients. Thiazide diuretics (THZ) are the most common treatment for volume overload and hypertension (HTN). This study examines the association between THZ usage and clinical outcomes among CKD patients in a nationwide cohort. Method: The total number of patients in the study was 24,312. After matching with one non-user randomly selected from the CKD population, we identified 8501 patients in the THZ and the comparison cohorts. Cox proportional hazards regression analysis was conducted to estimate the associations of THZ on the incidence of all-cause mortality, end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD), and stroke. Results: The all-cause mortality rate was significantly lower in THZ users than in non-users (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.60–0.71). The THZ usage was associated with a lower incidence of ESRD, AMI, PAOD, and stroke (P<0.05). In subgroup analysis, some significant clinical outcomes were related with CKD stages 3 and 4 (P<0.05); however, there were no clinical associations in CKD stage 5. In further THZ subtype analysis, there were clinical associations with fewer deaths, ESRD, AMI, and PAOD accompanying chlorthalidone treatment. Moreover, the indapamide prescription was linked to lower mortality, ESRD, AMI, and PAOD prevalence. However, there were significantly greater incidences of ESRD, CHF, and AMI in the metolazone users. Conclusion: THZ usage is associated with lower mortality and incidence of ESRD, AMI, PAOD, and stroke s in patients with CKD stages 3 and 4.

Publisher

Academy of Medicine, Singapore

Subject

General Medicine

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Thiazide diuretics in chronic kidney disease: Is there still a role?;Annals of the Academy of Medicine, Singapore;2023-10-31

2. Thiazide diuretics in chronic kidney disease: Is there still a role?;Annals of the Academy of Medicine, Singapore;2023-10-30

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