The urine metabolomic signature of distal diuretics and diuretic-induced hyponatremia in patients with chronic kidney disease

We assessed the urinary metabolomic fingerprint of treatment with amiloride and hydrochlorothiazide in individuals with CKD stages G3-G4. We identified enhanced ammoniagenesis in the absence of hypokalemia or metabolic acidosis. Patients who developed diuretic-induced hyponatremia exhibited a urinary metabolomic signature of oxidative stress. Our study highlights the interplay between "electrolyte and fluid balance" and "metabolic adaptations" in individuals with CKD who are treated with distal diuretics.