Chlorthalidone Versus Amlodipine for Hypertension in Kidney Transplant Recipients Treated With Tacrolimus: A Randomized Crossover Trial.
Moes AD, Hesselink DA, et al.American Journal of Kidney Diseases 2017; 69(6): 796-804.
Aims
To analyse the effect of the thiazide diuretic chlorthalidone in hypertensive kidney transplant recipients using tacrolimus.
Interventions
Participants were randomly assigned to start with chlorthalidone (12.5 mg) or amlodipine (5 mg) for 8 weeks, separated by a 2-week washout period.
Participants
49 hypertensive kidney transplant recipients aged ≥ 18 years treated with tacrolimus and a stable background of antihypertensive drugs.
Outcomes
The primary outcome measured was average daytime systolic blood pressure. Secondary outcomes included proteinuria, urinary calcium excretion, kidney function, and adverse effects.
Follow-up
8 weeks
CET Conclusions
This non-inferiority cross-over trial investigated the use of the thiazide diuretic chlorthalidone for the treatment of hypertension in renal transplant recipients. Recent evidence has suggested that CNI use may affect the thiazide-sensitive sodium chloride transporter, providing a rationale for the use of thiazide diuretics in CNI-treated recipients. Chlorthalidone demonstrated a similar reduction in blood pressure to amlodipine in this study, with a reduction in proteinuria and peripheral oedema. There are some caveats. Chlorthalidone use resulted in a reduction in eGFR from 58 to 50 ml/min. This recovered on switching to Amlodipine, but as follow-up was short it is not clear whether this effect is maintained or recovers with prolonged use. The study is not blinded, and analysis is per protocol. Withdrawal due to adverse events was higher in the Chlorthalidone arm. Certainly, use of thiazide diuretics in renal transplant recipients warrants further investigation with longer follow-up.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov - NCT02644395