Comparison between hydrochlorthiazide and diltiazem added on to angiotensin receptor blocker in reducing proteinuria in patients with chronic kidney disease

Proteinuria is an early marker of chronic kidney disease. The severity of proteinuria is an indicator of progressive loss of renal function especially when it co-exits with hypertension. Therefore, many drugs are used to reduce proteinuria and halt the progression of kidney disease. The primary endpoint was to compare the additive benefit of adding either hydrochlorothiazide or diltiazem in to an angiotensin receptor blocker in reducing proteinuria in patients with chronic kidney disease. The secondary endpoint was to identify which combination is more effective in improving renal function and blood pressure control. This is a randomized open-labeled study carried out in the nephrology department in Shar hospital/Sulaimani city in Iraq. It started from the 1^st of December 2013 to the 31^th of May 2014. Data from fifty-three patients were collected and then followed up for a period of six months. During this period patients were interviewed every two months and progress were documented. This study showed that patients on hydrochlorothiazide had a significant reduction in proteinuria and improvement in renal function throughout the visits compared to those on diltiazem (p=0.01). Although the diltiazem group had a lower systolic blood pressure by the end of the study but showed no significant changes in the means of all patients’ measurements. In conclusion Hydrochlorothiazide may be more effective than diltiazem in reducing proteinuria and improving renal function. On the other hand diltiazem is more likely to reduce systolic blood pressure.