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Abstract: TH-PO964

Hydrochlorothiazide for the Prevention of Kidney Stone Recurrence

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Fuster, Daniel G., Inselspital Universitatsspital Bern, Bern, Bern, Switzerland
  • Dhayat, Nasser, Inselspital Universitatsspital Bern, Bern, Bern, Switzerland
  • Bonny, Olivier, Universite de Lausanne, Lausanne, Vaud, Switzerland
  • Ritter, Alexander, UniversitatsSpital Zurich, Zurich, Zürich, Switzerland
  • Mohebbi, Nilufar, UniversitatsSpital Zurich, Zurich, Zürich, Switzerland
  • Faller, Nicolas, Inselspital Universitatsspital Bern, Bern, Bern, Switzerland
  • Pellegrini, Lisa, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
  • Venzin, Reto Martin, Kantonsspital Graubunden, Chur, Graubünden, Switzerland
  • Grosse MD, Philipp Bastian, Kantonsspital Graubunden, Chur, Graubünden, Switzerland
  • Hüsler, Carina, Kantonsspital Sankt Gallen, Sankt Gallen, SG, Switzerland
  • Koneth, Irene, Kantonsspital Sankt Gallen, Sankt Gallen, SG, Switzerland
  • Bucher, Christian, Kantonsspital Sankt Gallen, Sankt Gallen, SG, Switzerland
  • Gabutti, Luca, Regional Hospital Belllinzona, Bellinzona, Switzerland
  • Mayr, Michael, Universitatsspital Basel Bereich Medizin, Basel, Basel-Stadt, Switzerland
  • Odermatt, Urs, Kantonsspital Luzern, Luzern, Luzern, Switzerland
  • Buchkremer, Florian, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
  • Tamò, Luca, Inselspital Universitatsspital Bern, Bern, Bern, Switzerland
  • Cereghetti, Grazia Maria, Inselspital Universitatsspital Bern, Bern, Bern, Switzerland
  • Roumet, Marie Camille, Universitat Bern Medizinische Fakultat, Bern, Bern, Switzerland
  • Roth, Beat, Universite de Lausanne, Lausanne, Vaud, Switzerland
  • Trelle, Sven, Universitat Bern Medizinische Fakultat, Bern, Bern, Switzerland
Background

Nephrolithiasis is one the most frequent conditions affecting the kidney and characterized by a high risk of recurrence. Thiazide diuretics are widely used for kidney stone recurrence prevention, but data are limited regarding their efficacy as compared with placebo and any dose–response relationship.

Methods

In this double-blind trial, we randomly assigned patients with recurrent calcium-containing kidney stones to 12.5 mg, 25 mg or 50 mg hydrochlorothiazide or placebo once daily. The main objective was to investigate the dose–response relationship for prevention of the primary end point, a composite of symptomatic or radiologic recurrence.

Results

A total of 416 patients underwent randomization, median duration of follow-up was 2.92 years. A primary end point occurred in 60 of 102 patients (59%) receiving placebo, in 62 of 105 patients (59%) receiving 12.5 mg hydrochlorothiazide (rate ratio, 1.33; 95% confidence interval [CI], 0.92 to 1.93), in 61 of 108 patients (56%) receiving 25 mg hydrochlorothiazide (rate ratio, 1.24; 95% CI, 0.86 to 1.79), and in 49 of 101 patients (49%) receiving 50 mg hydrochlorothiazide (rate ratio, 0.92; 95% CI, 0.63 to 1.36). There was no linear relationship between hydrochlorothiazide dose and the primary end point (P=0.66). Hypokalemia, gouty arthritis and new onset diabetes mellitus occurred more frequently in patients assigned to hydrochlorothiazide compared to placebo.

Conclusion

Among patients with recurrent kidney stones, recurrence rates were not different between patients receiving once daily 12.5 mg, 25 mg or 50 mg hydrochlorothiazide or placebo. (Funded by the Swiss National Science Foundation; NOSTONE ClinicalTrials.gov number, NCT03057431).

Funding

  • Government Support - Non-U.S.