UChicago Medicine Primary Care e-Journal Club: Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease

March 1, 2022 to March 31, 2022
This activity will use an asynchronous e-learning model to facilitate engagement of with high-impact updates in the primary care literature that will improve patient care.
This article describes a randomized double-blind placebo controlled trial, which compared the addition of chlorthalidone vs. placebo to the anti-hypertensive regimen for selected patients with CKD4 and uncontrolled blood pressure (defined at >130/80).
The trial recruited 160 participants which were average aged of 62% male, 46% white, 32% black; mean eGFR 23; BP 141/73 on 3.4 antihypertensive drugs at baseline; 60% of patients in each group received loop diuretics; 99% of patients in each group received ACE/ARB or BB; 76% with DM, 37% with OSA, 25% with CAD; 20% current smokers; BMI 32.5; median urine albumin/creatinine ratio 837 mg/g.
The adjusted change in 24h SBP from baseline to 12 weeks was −11.0 mm Hg (95% 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. Urine albumin:creatinine ratio from baseline to 12 weeks was 50% lower in the chlorthalidone group vs placebo (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.
The number of patients was relatively small, with disproportionately few women, Asian patients, and Hispanic patients. Remaining concerns regarding concomitant use of loop and thiazide diuretics with regards to risk of hypokalemia and increased sCr. This short, small trial could not provide evidence on whether the significant BP reduction translates to cardiorenal benefits.
Contrary to received wisdom, these results suggest that that chlorthalidone, an inexpensive and widely available antihypertensive, is ineffective” as an antihypertensive agent in patients with advanced CKD. The addition of chlorthalidone, with close monitoring of GFR and electrolytes, may actually help improve BP control and slow progression of advanced CKD.

Target Audience

This activity is designed for physicians and other healthcare professionals that provide primary care to patients at UChicago Medicine.

Learning Objectives

At the conclusion of this activity, participants will be able to:

  • Describe the impact of adding a thiazide diuretic for blood pressure control in patients with advanced CKD;
  • Discuss differences between study population and your clinical practice;
  • Identify clinical circumstances in which you would  consider prescribing chlorthaidone for patients with CKD.
Additional information
ACGME/ABMS Core Competencies: 
Patient Care and Procedural Skills
Medical Knowledge
For more information, please contact:
CME Coordinator Contact Name: 
Katherine Sullivan
CME Coordinator Contact Email: 
CME Coordinator Contact Phone: 
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Event starts: 
03/01/2022 - 12:00am
Event ends: 
03/31/2022 - 11:59pm
Activity opens: 
Activity expires: 
  George Weyer, MD
  Assistant Professor of Medicine
  University of Chicago



Disclosure Declarations
As a provider accredited by the ACCME, The University of Chicago Pritzker School of Medicine asks everyone in a position to control the content of an education activity to disclose all financial relationships with any ineligible companies. This includes any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Financial relationships are relevant if a financial relationship, in any amount, exists between the person in control of content and an ineligible company during the past 24 months, and the content of the education is related to the products of an ineligible company with whom the person has a financial relationship. Mechanisms are in place to identify and mitigate any relevant financial relationships prior to the start of the activity.

Additionally, The University of Chicago Pritzker School of Medicine requires Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.

Physician Credit
The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Chicago Pritzker School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Other Healthcare Professional Credit
Other healthcare professionals will receive a Certificate of Participation. For information on the applicability and acceptance of Certificates of Participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME, please consult your professional licensing board.
Please Note: The credit claiming process will close three months after the conference end date. Requests to claim credit after three months will be subject to additional fees.
Registration: This course is only open to University of Chicago affiliates.
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