Chlorthalidone in Advanced Chronic Kidney Disease — Have We Missed a Trick?

This editorial reviews the CLICK trial, which tested chlorthalidone in patients with stage 4 chronic kidney disease (CKD). Despite historical reluctance to use thiazide-like diuretics in advanced CKD due to assumed inefficacy, the trial found a significant systolic blood pressure reduction (−11 mm Hg with chlorthalidone vs. −0.5 mm Hg with placebo). Secondary outcomes suggested possible renal benefit via reduced albuminuria and reversible eGFR decline. The piece discusses how chlorthalidone may complement ACE inhibitors or ARBs by lowering intraglomerular pressure and advocates for longer-term trials assessing cardiovascular and renal outcomes. It concludes that chlorthalidone is a promising, cost-effective antihypertensive in advanced CKD, warranting reconsideration in treatment strategies.

This editorial reviews the CLICK trial, which tested chlorthalidone in patients with stage 4 chronic kidney disease (CKD). Despite historical reluctance to use thiazide-like diuretics in advanced CKD due to assumed inefficacy, the trial found a significant systolic blood pressure reduction (−11 mm Hg with chlorthalidone vs. −0.5 mm Hg with placebo). Secondary outcomes suggested possible renal benefit via reduced albuminuria and reversible eGFR decline. The piece discusses how chlorthalidone may complement ACE inhibitors or ARBs by lowering intraglomerular pressure and advocates for longer-term trials assessing cardiovascular and renal outcomes. It concludes that chlorthalidone is a promising, cost-effective antihypertensive in advanced CKD, warranting reconsideration in treatment strategies.