What is your approach to thiazide diuretic use in those with uncontrolled hypertension and advanced chronic kidney disease?

The Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease (CLICK) trial provides an answer to this question. Chlorthalidone is still effective at lowering BP when eGFR is 15-30 mL/min/1.73m^2. Personally, I find it helpful to continue chlorthalidone in advanced CKD to help with kaliures...

I use thiazides to treat hypertension in dialysis patients, anuric or not. The drug’s mechanism of action has nothing to do with its diuretic properties; rather it appears to have an effect on endothelial sodium content and peripheral resistance. This became apparent many years ago when the standard...