Is there a preferred diuretic class for patients with renal impairment and hypertension?

It is widely believed that “high-ceiling” loop diuretics are required in patients with renal impairment and that “low-ceiling” thiazides are not sufficiently potent to cause meaningful natriuresis and diuresis. If this statement is true, at what level of renal function do thiazides lose their punch? Another related issue is the enlightened use of diuretic combinations. Use of diuretics in chronic kidney disease and hypertension has been addressed in the many guidelines, but further insight is provided in this installment of the “Controversies” series by two well-known authorities, William Elliott, M.D. Ph.D. and Rajiv Agarwal, M.D. [ABSTRACT FROM AUTHOR]