Are thiazide diuretics safe and effective antihypertensive therapy in kidney transplant recipients?
OBJECTIVE
There are no published studies assessing the safety and efficacy of thiazides as antihypertensives in kidney transplantation (KTX).


METHODS
This was a longitudinal retrospective cohort study conducted in adult KTX recipients. Patients were grouped based on receiving thiazides following KTX. Safety and efficacy comparisons were made between thiazide recipients and unexposed patients, as well as change in blood pressure (BP) within thiazide patients.


RESULTS
1,093 patients were included (thiazide group: 108, unexposed group: 985). Mean follow-up was 7.3 ± 4.5 years. Thiazide recipients were older (53 ± 11 vs. 48 ± 13 years, p < 0.001) and more likely to be female (52 vs. 41%, p = 0.023) and have pre-KTX hypertension (97 vs. 88%, p = 0.004) or diabetes (36 vs. 27%, p = 0.035). After controlling for baseline differences, safety analysis revealed thiazide recipients were not more likely to be readmitted to the hospital, but were at higher risk to develop hyperkalemia (56 vs. 38%, p < 0.001) or hypokalemia (28 vs. 18%, p = 0.010), with similar rates of hypotension, decreased estimated glomerular filtration rate, graft loss and death. Efficacy analysis demonstrated systolic (147 ± 17 to 139 ± 18 mm Hg, p < 0.001) and diastolic (79 ± 9 to 77 ± 11 mm Hg, p < 0.001) BPs were significantly reduced after thiazide initiation. Compared to unexposed patients, thiazide recipients had higher mean BPs during the entire follow-up (142/78 vs. 136/77, p < 0.001), with similar BPs while on thiazides and comparable rates of goal BPs (<130/80 mm Hg, 32 vs. 36%, p = 0.219).


CONCLUSIONS
In KTX, based on long-term outcomes, thiazides appear to be safe and effective antihypertensives; in the short-term, thiazides may increase the risk of developing potassium disturbances.
Division of Transplant Surgery, Medical University of South Carolina, Charleston, S.C., USA.
David J
DJ
Taber
Titte M
TM
Srinivas
Nicole A
NA
Pilch
Holly B
HB
Meadows
James N
JN
Fleming
John W
JW
McGillicuddy
Charles F
CF
Bratton
Beje
B
Thomas
Kenneth D
KD
Chavin
Prabhakar K
PK
Baliga
Leonard E
LE
Egede
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D048909:Diabetes Complications / Q000209:etiology; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011188:Potassium / Q000378:metabolism; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D049971:Thiazides / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004232:Diuretics; D049971:Thiazides; D011188:Potassium