Of the currently available antihypertensive agents, thiazides and thiazide-like diuretics are most often used and have been assessed in many RCTs involving CKD patients, either as the primary investigational agent or as an add-on therapy. Their side-effect profile is well known and their pharmacology has recently been extensively reviewed,115 as has their role in treating hypertension.115,117,118 Although salt and water excretion may initially account for their antihypertensive effect, why they lower BP over the long term is less well understood and may involve direct or indirect The metabolic side effects (hyper- glycemia, hyperuricemia, visceral adiposity) are also not but should be considered in patients at risk of metabolic syndrome. There are 2 broad groups of thiazide-type diuretics: thiazides whose names end in thiazide, and thiazide-like agents such as chlorthalidone and indapamide. In recent years, the thiazide diuretics have been used in low doses in treatment of hypertension (hydrochlororthizide 12.5 to 25 mg, bendroflumethiazide 2.5 mg daily). The valid compar- ison is thus of low dose thiazide versus thiazide-like diuretic. These regimens have been compared in the recent UK National Institute for Health and Clinical Excellence (NICE) guidelines on primary hypertension.117 There was limited evidence of any differences in BP control, clinical outcomes or cost-effectiveness. NICE recommended that in newly treated primary hypertensives, the thiazide-like diuretics were preferable to the thiazides, based on the larger volume of evidence for efficacy. The relevance of these observations to CKD patients is unclear. Dose considerations in CKD patients. Although thiazides are excreted by the kidney, no dose adjustment is recom- mended in patients with reduced GFR. 