Which type of diuretic is preferred in treating hypertension in chronic kidney disease?

Loop diuretics are preferred in treating hypertension in patients with chronic kidney disease (CKD) primarily due to their potent diuretic effect and their ability to effectively reduce fluid overload. In CKD, the kidneys' ability to excrete sodium and water is impaired, leading to volume overload and hypertension. Loop diuretics, such as furosemide, are particularly useful because they act on the ascending loop of Henle, inhibiting sodium and chloride reabsorption and thus promoting diuresis even in cases of decreased kidney function.

These diuretics are effective at lower glomerular filtration rates than other classes, such as thiazides, which may not be as effective in advanced stages of CKD. The ability of loop diuretics to create a significant diuretic response makes them suitable for managing fluid overload associated with hypertension in this patient population. Additionally, they are often utilized to manage other complications of CKD, such as heart failure, where fluid management is critical.

Other diuretics, such as thiazides, may have limited effectiveness due to the declining renal function in CKD, while potassium-sparing diuretics are typically used in conjunction with other diuretics to prevent potassium loss rather than as