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Kidney Week

Abstract: FR-OR17

Chlorthalidone and Bumetanide in Advanced CKD: HEBE Trial

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Solis-Jimenez, Fabio, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Perez-Navarro, L. Monserrat, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Valdez-Ortiz, Rafael, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
Background

Current treatment for hypertension and volume overload in chronic kidney disease consists of loop diuretics, nevertheless, chronic use leads to adaptive changes at the distal nephron, which in turn decreases their efficacy. The use of thiazide diuretics could be another treatment option in these patients, notwithstanding, there’s not enough evidence to justify their use in this population.

Methods

To evaluate the efficacy and safety of treatment with bumetanide plus chlorthalidone in patients with advanced chronic kidney disease a double-blind randomized controlled trial was conducted.

Results

Thirty-two patients with hypertension, chronic kidney disease stage IV/V, and chronic loop diuretic use where divided in two groups. The dual treatment group received bumetanide (2 mg BID) plus chlorthalidone (50 mg BID), while the control group was given bumetanide (2 mg BID) plus placebo, both for twenty-eight days. There was a decrease of systemic blood pressure in the dual treatment group when compared with the control group; systolic blood pressure -26.1±15.3 vs. -10±23.3 mmHg (p=0.028), diastolic blood pressure -13.5±10.7 vs. -3.4±11.9 mmHg (p=0.018), and mean arterial pressure -18.1±8.7 vs. -5.4±14.3 mmHg (p=0.006). There was also a decrease of volume overload in the dual treatment group when compared to the control group; total body water -4.36±3.29 vs. +0.075±1.78 liters (p<0.001), extracellular water -2.55±1.1 vs. +0.150±1.2 liters (p<0.001), and extracellular water to total body water ratio -2.92±4.76 vs. -0.24±1.42 (p=0.039).

Conclusion

In advanced chronic kidney disease plus hypertension patients whose treatment with loop diuretics is insufficient, combined use of bumetanide plus chlorthalidone can be useful for systemic blood pressure and volume overload control.

Funding

  • Commercial Support