ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO583

Effects of Diuretics Furosemide and Hydrochlorothiazide on CKD-MDB: A Prospective Randomized Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Vasco, Raquel F. V., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
  • Moyses, Rosa M.A., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
  • Elias, Rosilene M., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
Background

Diuretics are often prescribed to patients with CKD to control fluid overload and hypertension. Diuretics may affect CKD-MBD since thiazides are associated with reduced calciuria, reduction/maintenance of PTH levels and increased bone density while loop diuretics have the opposite effect. These effects are still debatable and not fully elucidated in patients with CKD. Objective: To evaluate the effects of furosemide (FURO) and hydrochlorothiazide (HYDRO) on CKD-BMD in patients with stage 3 CKD in a regular follow-up.

Methods

This was a RCT comparing HYDRO (25mg/day) and FURO (40mg/day) on urinary and biochemical variables including parathyroid hormone (PTH), alkaline phosphatase (AP), calcium (Ca), CTx and P1NP. After a washout period, patients were randomized to either the HYDRO or FURO group and followed for 1 year, by the same observer, blinded to randomization. Bone effects were also evaluated by Dual X-ray absorptiometry (DXA).

Results

40 patients with a median of 62 years were included, 20 were randomized to each group, which presented similar characteristics after randomization (for age, gender, eGFR, weight, PTH, Ca, 25(OH)Vitamin-D, and AP). There was a reduction of urinary Ca in the HYDRO group and an increase in the FURO group (p=0.02), in addition to a tendency of a higher total serum Ca in the HYDRO group (p=0.06). There was no difference in PTH and 25(OH)Vitamin-D levels, albeit there was an annual percentage increase of 1,25 (OH)2ViTD in the FURO group (12.7 ± 32%) and a reduction in the HYDRO group (-13.6 ± 21%), p=0.048. CTX, P1NP, and AP increased in the FURO group and reduced in the HYDRO group (all p<0.05). No significant difference was found in the percentage change of bone density measured by DXA, only a tendency to greater loss in the proximal 1/3 of the distal radius, more pronounced in the FURO group (p=0.06).

Conclusion

Furosemide and hydrochlorothiazide had opposite effects on the CKD-MBD in a 1-year follow-up study. Furosemide seems to be associated with an increase and hydrochlorothiazide with reduced bone remodeling, a fact not evidenced by PTH change. Whether PTH would change in more advanced CKD or in a bigger sample size warrants further investigation.