Do you avoid prescribing thiazide diuretics for hypertension management in ADPKD patients, given concerns about vasopressin release?

No. Although thiazide diuretics may theoretically increase vasopressin secretion through mild volume contraction, there is currently no clinical evidence that this adversely affects ADPKD progression or should preclude their use. Notably, the HALT-PKD trials, data from which established much of our current blood pressure management strategy in ADPKD, permitted the use of thiazide diuretics as part of standardized antihypertensive therapy. Consistent with these data, the 2025 KDIGO ADPKD guidelin...