Abstract: FR-PO0355
Use of Furosemide, When Compared with Thiazides, Is Associated with Worse Kidney Outcomes in Patients with Type 2 Diabetes and Hypertension
Session Information
- Diabetic Kidney Disease: Progression, Predictive Tools, Therapeutics, and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Meisel, Eshcar, Rabin Medical Center, Petah Tikva, Center District, Israel
- Agur, Timna, Rabin Medical Center, Petah Tikva, Center District, Israel
- Rozen-Zvi, Benaya, Rabin Medical Center, Petah Tikva, Center District, Israel
Background
Diuretic therapy is a longstanding treatment for hypertension, constituting a cornerstone of the antihypertensive regimen. Both thiazides and loop diuretics are known for their blood pressure-lowering effects. Although loop diuretics are not considered first-line therapy for hypertension, they are still widely used among physicians in various clinical settings, including hypertension. While loop diuretics are recognized for their efficacy in advanced CKD, there is growing evidence for the utility of thiazides/thiazide-like diuretics in advanced CKD. Consequently, the effect of these medications on kidney function is a matter of investigation. We aimed to investigate the long-term influence of thiazide versus furosemide on renal function and survival in a large cohort of patients with type 2 diabetes.
Methods
Patients treated with thiazides were matched in a 1:1 ratio with furosemide-treated patients using propensity score matching. The primary outcome was a renal composite outcome defined as ≥ 40% reduction in eGFR, eGFR below 15 ml/min/1.73m2, or initiation of dialysis, as well as overall mortality. The slope of GFR over five years was also evaluated. A Cox proportional hazard model was used for outcome analysis.
Results
The study included 4106 patients (2053 in each group). The median follow-up was 1322 days. During the study period, furosemide use was significantly associated with the renal composite outcome, i.e., kidney disease progression, in both univariate and multivariate analyses (HR 1.649, 95% CI 1.32-2.06 and 1.662, 95% CI 1.33-2.08, respectively). Additionally, furosemide use was associated with an increased risk of mortality and hospitalizations within the first-year post-enrollment (HR 1.765, 95% CI 1.54-2.03 and 1.423, 95% CI 1.29-1.57 with multivariate analysis, respectively).
Conclusion
Our data suggests a renal and survival benefit with the use of thiazide versus furosemide in patients with type 2 diabetes treated with diuretics. Further studies should evaluate this important question.