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Thiazides diuretics in the treatment of nephrolithiasis: are we using them in an evidence-based fashion?

  • Nephrology – Original Paper
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Abstract

In the 1980s a change occurred in hydrochlorothiazide prescribing practices for hypertension from high-dose (50 mg/day) to low-dose (12.5–25 mg/day) therapy. However, randomized controlled trials (RCT) for prevention of calcium-containing kidney stones (CCKS) employed only high doses (≥50 mg/day). We hypothesized that these practices have resulted in underdosing of hydrochlorothiazide for prevention of CCKS. Patients with a filled prescription for thiazide diuretics that underwent a 24-h urine stone risk factor analysis were eligible. Those with evidence that thiazide was prescribed for CCKS were further analyzed. Of 107 patients, 102 were treated with hydrochlorothiazide, 4 with indapamide, and one with chlorthalidone. Only 35% of hydrochlorothiazide-treated patients received 50 mg/day; a dose previously shown to reduce stone recurrence. Fifty-two percent were prescribed 25 mg and 13% 12.5 mg daily, doses that were not studied in RCT. Evidence-based hydrochlorothiazide use was suboptimal regardless of where the patient received care (Nephrology or Endocrinology clinic). In a small subset of patients (n = 6) with 24-h urinary calcium excretion measured at baseline and after 2 hydrochlorothiazide doses (25 and ≥50 mg), there was a trend toward decreased urinary calcium excretion as the dose was increased from 25 to ≥50 mg/day (p = 0.051). Low-dose hydrochlorothiazide was often used for prevention of CCKS despite the fact that there is no evidence that it is effective in this setting. This may have resulted from a practice pattern of using lower doses for hypertension therapy or a lack of knowledge of RCT results in treatment of CCKS.

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Acknowledgments

This work was supported by the University of Texas Southwestern Medical Center O’Brien Kidney Research Core Center (P30DK079328).

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Authors and Affiliations

  1. Department of Medicine, VA North Texas Heath Care System, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-8856, USA

    Rebecca Vigen

  2. Pharmacy Service, VA North Texas Heath Care System, Dallas, TX, 75216, USA

    Rick A. Weideman

  3. VA North Texas Heath Care System, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-8856, USA

    Robert F. Reilly

  4. Section of Nephrology, VA North Texas Health Care System, Mail code-111, 4500 S. Lancaster Rd, Dallas, TX, 75216, USA

    Robert F. Reilly

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  1. Rebecca Vigen
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  2. Rick A. Weideman
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Correspondence to Robert F. Reilly.

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Vigen, R., Weideman, R.A. & Reilly, R.F. Thiazides diuretics in the treatment of nephrolithiasis: are we using them in an evidence-based fashion?. Int Urol Nephrol 43, 813–819 (2011). https://doi.org/10.1007/s11255-010-9824-6

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  • DOI: https://doi.org/10.1007/s11255-010-9824-6

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