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“CLICK”ing with Chlorthalidone: Rediscovering an Old Drug for Advanced CKD

  • 1 Jamie S. Hirsch, MD, is with the Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY. Michael Turk, DO, is a PGY-2 Internal Medicine resident at Allegheny General Hospital, Pittsburgh, PA.
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“There's something special about chlorthalidone.”

–Rajiv Agarwal, MD, as heard on “Freely Filtered”

The nephrology community was abuzz at ASN Kidney Week 2021 as Rajiv Agarwal presented the results of the Chlorthalidone in Chronic Kidney Disease (CLICK) trial, with simultaneous publication in The New England Journal of Medicine (1).

In an attempt to refute the dogma that thiazide-like diuretics lose effectiveness at low estimated glomerular filtration rate (eGFR) (2), the CLICK trial enrolled 160 patients with stage 4 chronic kidney disease (CKD; eGFR 15 to >30 mL/min/1.73 m2) and uncontrolled hypertension—defined as a mean

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