Objective To explore application of long-term diuretics and sodium restriction in the treatment of patients with chronic kidney disease and hypertension(CKD).Methods From September 2019 to March 2021,26 patients with chronic primary nephropathy and hypertension who were treated in our hospital were selected.They were treated with amiloride/hydrochlo-rothiazide(5 mg/50 mg per day)and dietary sodium(60 mmol/d).Effects on blood pressure,renal function and fluid balance were analyzed and correlated with the renal clearance rate of diuretics.Results Dietary sodium restriction reduced sodium excretion from 160 mmol/L to 64 mmol/L per day.Compared with sodium restriction(SBP from 134 mmHg to 129 mmHg),diuretics caused 24 h average systolic blood pressure(SBP from 138 to 124 mmHg)produced a greater reduction,and had a significant impact on ex-tracellular water,glomerular filtration rate(eGFR),plasma renin and aldosterone.Both interventions resulted in body weight and N-terminal brain Pre-natriuretic peptide(NT-proBNP)decreased and did not significantly reduce albuminuria,while diuretics sig-nificantly reduced excretion of urinary angiotensinogen and β2-microglobulin.Despite the lower eGFR and higher plasma indoxyl sulfate was associated with a lower diuretic clearance rate,but still maintained a diuretic effect on body weight and blood pressure at a lower eGFR.During diuretic treatment,higher PGE2 excretion was associated with lower free water clearance,and 4 patients developed mild hyponatremia.Conclusion Long-term diuretics are not inferior to dietary sodium restriction in reducing blood pressure and extracellular volume of CKD.Although diuretic clearance is low,patients with CKD still maintain diuretic sensitivity.
维普
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