STOP Thiazides to prevent recurrent kidney stones??
6 Mar 2023 • Hydrochlorothiazide, a medication that has long been used to treat calcium-containing kidney stones, did not reduce the frequency of stone recurrence in the NOSTONE randomised controlled study, 416 patients were randomly randomised to take hydrochlorothiazide 12.5 mg, 25 mg, or 50 mg daily or a placebo; the rates of stone recurrence within 3 years were comparable in each group. A composite primary endpoint event occurred in 59%, 56%, 49%, and 59% of patients, respectively, in the hydrochlorothiazide dosage groups of 12.5 mg, 25 mg, 50 mg, and placebo. 38%, 40%, 28%, and 34% of patients, respectively, experienced a symptomatic kidney stone recurrence. Recurrence of radiologic kidney stones was seen in 45%, 32%, 34%, and 49% of patients, respectively. Instead with hydrochlorothiazide, side effects were more frequent. The New England Journal of Medicine published the findings on March 2. These findings raise concerns about the use of thiazide and thiazide-like diuretic medications, which have grown to be accepted medical practices for preventing kidney stone recurrence, according to Fuster of the Department of Nephrology and Hypertension at Bern University Hospital in Switzerland. He also pointed out that while individuals receiving hydrochlorothiazide had lower levels of urine citrate, which is protective, compared to those receiving placebo, they also had lower levels of urine calcium, which encourages the formation of stones.
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