{"id":"f611f28b121c","type":"article","url":"https://hartvaat.nl/2021/12/30/chlorthalidon-bij-hypertensie-met-gevorderde-ckd-nejm-click/","title":"Chlorthalidon bij hypertensie met gevorderde CKD: NEJM CLICK","title_en":"Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2110730","source_url":"https://doi.org/10.1056/NEJMoa2110730","authors":["Rajiv Agarwal","Arjun D Sinha","Andrew E Cramer","Mary Balmes-Fenwick","Jazmyn H Dickinson","Fangqian Ouyang","Wanzhu Tu"],"significance":9,"published":"2021-12-30","source_date":"2021-12-30","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/","https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/"],"congress":"","summary_en":"The CLICK trial demonstrated that chlorthalidone effectively lowered blood pressure in patients with advanced CKD (eGFR 15-30 mL/min), a population traditionally thought unresponsive to thiazide diuretics. This evidence-changing result supported the use of thiazide-like diuretics even in severe kidney disease.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM CLICK trial die chlorthalidon onderzocht bij hypertensie met gevorderde CKD. Eerste bewijs dat thiazide-achtig diureticum effectief is bij ernstige nierinsufficiëntie.","abstract_original":"BACKGROUND: Little evidence has been available to support the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease. METHODS: We randomly assigned patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo; randomization was stratified according to previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks. Secondary outcomes were the change from baseline to 12 weeks in the urinary albumin-to-creatinine ratio, N-terminal pro-B-type natriuretic peptide level, plasma renin and aldosterone levels, and total body volume. Safety was also assessed. RESULTS: A total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics. At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4. At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively. The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mm Hg (95% confidence interval [CI], -13.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. The between-group difference was -10.5 mm Hg (95% CI, -14.6 to -6.4) (P<0.001). The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points (95% CI, 37 to 60). Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group. CONCLUSIONS: Among patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. (Funded by the National Heart, Lung, and Blood Institute and the Indiana Institute of Medical Research; CLICK ClinicalTrials.gov number, NCT02841280.)."}