Is population-wide diuretic use directly associated with the incidence of end-stage renal disease in the United States?
In the quest for "evidence-based" medicine, an accepted hierarchy of evidence has been proposed. This hierarchy places in vitro studies and animal data at the base, and puts systematic reviews, meta-analyses, and randomized controlled trials at the pinnacle. However, when clinical medicine faces questions that have not yet been studied by the "gold standard" methods, how is one to proceed? Often, the best evidence at hand falls short of randomized controlled trials and meta-analyses. Using this framework, a review of the evidence supporting the hypothesis that population-wide diuretic use is directly associated with end-stage renal disease in the United States is presented. Publications pertaining to diuretic use in recent clinical trials are also discussed.
Hawkins
Ralph G
RG
Hypertension and Nephrology, Manitoba Clinic, 790 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1M3. rhawkins@manitobaclinic.com
D000818:Animals; D004232:Diuretics / Q000009:adverse effects*; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000453:epidemiology*; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology
D004232:Diuretics