Similar outcomes seen with chlorthalidone, hydrochlorothiazide among veterans
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Key takeaways:
- Patients in a Veterans Affairs study who took two common diuretics showed no difference in outcomes for progression to chronic kidney disease.
- Patients on chlorthalidone had more cases of hypokalemia.
LONG BEACH, Calif. — Progression toward chronic kidney disease was similar in a Veterans Affairs Health Care System study of patients on either chlorthalidone or hydrochlorothiazide, according to a study presented here.
“Hypertension is a risk factor for the development and progression of CKD. Prior studies have suggested a greater rate of progression of eGFR and a greater incidence of CKD with chlorthalidone (CTD) compared to hydrochlorothiazide (HCTZ),” Areef Ishani, MD, MS, of the Minneapolis VA Health Care System Primary Care and Specialty Care Integrated Care Community and director and professor of medicine at the University of Minnesota, and colleagues wrote in a poster presented at the National Kidney Foundation Spring Clinical Meetings. “The [Diuretic Comparison Project] has previously demonstrated cardiovascular outcomes among those with and without CKD (eGFR <60 mL/min2) at baseline. This analysis evaluates renal outcomes comparing CTD and HCTZ in patients with hypertension.”
In the trial, more than 12,000 veterans were randomized to either continue HCTZ or switch to CTD. “For this analysis, the primary outcome was progression of CKD, defined as a doubling of creatinine, a terminal eGFR of [less than]10 mL/min2 or kidney failure requiring treatment (KFRT),” the authors wrote. “Sensitivity analysis included an alternate definition of progression (40% reduction in eGFR, eGFR <10 mL/min2 or KFRT).”
Follow-up for the trial was 3.9 years.
Ishani told Healio that it remained unclear what the Veterans Affairs Health Care System would do in terms of changing policy on prescribing the two hypertensive medications. “Providers should be free to choose either drug,” Ishani said. “They are both relatively cheap, and I would push the combination of the pills as well.”
Ishani said the study did show a higher number of cases of hypokalemia among veterans who used CTD. “I think that is significant,” Ishani said. “I think if someone was to choose [CTD], then I think people should monitor for hypokalemia and treat it where appropriate.”
The study “found no significant disparity in renal outcomes between patients treated with chlorthalidone and those treated with hydrochlorothiazide,” according to a press release. “Specifically, there was no marked difference observed in the primary composite renal outcome, including doubling of serum creatinine, eGFR or kidney failure requiring treatment between the two treatment groups.
“The study revealed that the total slope of eGFR change and the incidence of CKD were comparable between patients receiving chlorthalidone and hydrochlorothiazide, suggesting similar efficacy in preserving kidney function,” according to the release.
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Ishani A, et al. Poster 447. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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