To Pee or Not to Pee: Diuretics in CKD

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

Could stopping a diuretic to protect kidney function actually make a patient more unwell?

In this episode of For Kidneys Sake, Dr Andrew Frankel and Dr Jeremy Levy tackle common misconceptions about diuretics in chronic kidney disease (CKD). They explain why diuretics are used to treat high blood pressure and fluid retention, why a small change in kidney function during treatment is not always a reason to stop, and why thiazide diuretics can still work when kidney function is reduced.

They also share practical points on choosing between thiazide and loop diuretics, responding when fluid retention persists, and adjusting treatment as a patient’s weight and swelling change. Throughout, they stress the importance of sodium restriction and monitoring kidney function, electrolytes and weight, especially when higher doses or combinations of diuretics are needed.

Five takeaways

1. Diuretics do not generally cause CKD to progress, though excessive fluid loss can cause acute kidney injury.
2. Thiazide diuretics can still help control blood pressure in people with advanced CKD.
3. Loop diuretics are usually more effective for fluid retention; the episode explains why furosemide may need more than one daytime dose.
4. Persistent swelling calls for a review of sodium intake and treatment. Combining diuretics can be effective, but needs close monitoring.
5. Follow weight, symptoms, kidney function and electrolytes during treatment, and reassess the dose as fluid overload resolves.

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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