Commentary

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Abstract
To ascertain whether diuretics have an antihypertensive effect independent of natriuresis, 12 stable patients on maintenance hemodialysis underwent a crossover evaluation with hydrochlorothiazide, 50 mg daily, metolazone, 5 mg daily, or placebo in 4‐wk treatment periods for 6 mo. Compliance was assured by pill counts and serum drug concentrations. All patients had daily urine < 100 mi. Pre‐ and postdialysis blood pressure, body weight, plasma volume, and plasma renin activity were monitored. Over the 6‐mo study period there were no statistically significant changes in any parameter related to diuretic therapy. It is concluded that afunctioning kidney with the ability to respond to diuretics with a natriuresis is necessary for the antihypertensive action of diuretics. Direct vascular effects of diuretics to lower peripheral resistance could not be demonstrated in this unique patient population.

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