Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence

Area of Science:

• Nephrology
• Pharmacology

Background:

• Nephrolithiasis (kidney stones) has a high recurrence rate.
• Thiazide diuretics are commonly used for prevention, but evidence is limited.
• Dose-response data for thiazides in kidney stone prevention are scarce.

Purpose of the Study:

• To investigate the dose-response effect of hydrochlorothiazide for preventing recurrent calcium-containing kidney stones.
• To compare the efficacy of different hydrochlorothiazide doses (12.5 mg, 25 mg, 50 mg) against placebo.
• To assess the safety of hydrochlorothiazide in patients with recurrent kidney stones.

Main Methods:

• A double-blind, randomized trial involving 416 patients with recurrent calcium kidney stones.
• Patients received daily hydrochlorothiazide (12.5 mg, 25 mg, or 50 mg) or placebo.
• Primary endpoint was symptomatic or radiologic kidney stone recurrence; follow-up was a median of 2.9 years.

Main Results:

• No substantial difference in recurrence rates was observed between hydrochlorothiazide groups and the placebo group.
• The 50 mg hydrochlorothiazide group showed a rate ratio of 0.92 (95% CI, 0.63 to 1.36) versus placebo.
• Adverse events like hypokalemia and gout were more frequent with hydrochlorothiazide.

Conclusions:

• Hydrochlorothiazide, at doses of 12.5 mg, 25 mg, or 50 mg daily, did not significantly reduce kidney stone recurrence compared to placebo.
• No clear dose-response relationship was identified for hydrochlorothiazide in preventing kidney stone recurrence.
• The study highlights potential side effects associated with hydrochlorothiazide use in this patient population.