In a patient with chronic kidney disease and stable blood pressure, what medication change should be made if their renal function declines?

In patients with chronic kidney disease (CKD), thiazide diuretics are often used for hypertension management; however, their efficacy diminishes as renal function declines. Thiazide diuretics typically become ineffective when the creatinine clearance falls below 30 mL/min. In this situation, the guideline is to discontinue thiazide diuretics because they will no longer provide the intended diuretic effect and may contribute to adverse outcomes such as electrolyte imbalances.

It is crucial for healthcare providers to assess renal function regularly and adjust medications accordingly. By discontinuing thiazide diuretics in a patient whose renal function has declined, one can avoid unnecessary risks and consider alternative antihypertensive agents that remain effective at lower levels of kidney function. This change is essential for ensuring safe and effective management of hypertension in patients with CKD.