Faculty Collaboration Database

Are thiazide diuretics safe and effective antihypertensive therapy in kidney transplant recipients? Am J Nephrol 2013;38(4):285-91

Date

09/26/2013

Pubmed ID

24061145

DOI

10.1159/000355135

Scopus ID

2-s2.0-84887091378 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

BACKGROUND/AIMS: There are no published studies assessing the safety and efficacy of thiazides as antihypertensives in kidney transplantation (KTX).

METHODS: This was a longitudinal retrospective cohort study conducted in adult KTX recipients. Patients were grouped based on receiving thiazides following KTX. Safety and efficacy comparisons were made between thiazide recipients and unexposed patients, as well as change in blood pressure (BP) within thiazide patients.

RESULTS: 1,093 patients were included (thiazide group: 108, unexposed group: 985). Mean follow-up was 7.3 ± 4.5 years. Thiazide recipients were older (53 ± 11 vs. 48 ± 13 years, p < 0.001) and more likely to be female (52 vs. 41%, p = 0.023) and have pre-KTX hypertension (97 vs. 88%, p = 0.004) or diabetes (36 vs. 27%, p = 0.035). After controlling for baseline differences, safety analysis revealed thiazide recipients were not more likely to be readmitted to the hospital, but were at higher risk to develop hyperkalemia (56 vs. 38%, p < 0.001) or hypokalemia (28 vs. 18%, p = 0.010), with similar rates of hypotension, decreased estimated glomerular filtration rate, graft loss and death. Efficacy analysis demonstrated systolic (147 ± 17 to 139 ± 18 mm Hg, p < 0.001) and diastolic (79 ± 9 to 77 ± 11 mm Hg, p < 0.001) BPs were significantly reduced after thiazide initiation. Compared to unexposed patients, thiazide recipients had higher mean BPs during the entire follow-up (142/78 vs. 136/77, p < 0.001), with similar BPs while on thiazides and comparable rates of goal BPs (<130/80 mm Hg, 32 vs. 36%, p = 0.219).

CONCLUSIONS: In KTX, based on long-term outcomes, thiazides appear to be safe and effective antihypertensives; in the short-term, thiazides may increase the risk of developing potassium disturbances.

Author List

Taber DJ, Srinivas TM, Pilch NA, Meadows HB, Fleming JN, McGillicuddy JW, Bratton CF, Thomas B, Chavin KD, Baliga PK, Egede LE

Authors

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Beje Thomas MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Antihypertensive Agents
Blood Pressure
Diabetes Complications
Diuretics
Female
Glomerular Filtration Rate
Humans
Hyperkalemia
Hypertension
Kidney Transplantation
Longitudinal Studies
Male
Middle Aged
Patient Readmission
Potassium
Renal Insufficiency
Retrospective Studies
Risk
Thiazides
Treatment Outcome