Prevention of kidney stones with Hydrochlorothiazide

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Created On: 14/02/2025

This double-blind, randomized trial assessed the efficacy of different doses of Hydrochlorothiazide in preventing kidney stone (nephrolithiasis) recurrence compared to a placebo.

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Key take away

Hydrochlorothiazide, regardless of dose, does not significantly reduce the recurrence of kidney stones, emphasizing the need for alternative interventions in managing high-risk patients.

Background

This double-blind, randomized trial assessed the efficacy of different doses of Hydrochlorothiazide in preventing kidney stone (nephrolithiasis) recurrence compared to a placebo.

Method

Patients with a history of recurrent calcium-containing kidney stones were assigned to receive either Hydrochlorothiazide dosed at 12.5, 25 or 50 mg every day, or a placebo. The dose-response effect on kidney stone recurrence (described as either symptomatic or radiologic recurrence) was the main objective of the study. Radiologic recurrence was identified as the formation of new stones or the growth of preexisting stones observable on the baseline imaging. Safety outcomes were also observed.

Result

A total of 416 patients were enrolled (median follow-up of 2.9 years). Primary endpoint events appeared in 59% of patients (60/102 patients) in the placebo group, similarly in 59% of patients (62/105 patients) in the 12.5 mg Hydrochlorothiazide group, 56% of patients (61/108 patients) in the 25 mg group, and 49% of patients (49/101 patients) in the 50 mg group.

The Hydrochlorothiazide dose and recurrence (P = 0.66) did not have any notable difference. Compared to the placebo, the adverse events (hypokalemia, gout, new-onset diabetes, skin allergies, and elevated plasma creatinine levels) were more common in the Hydrochlorothiazide groups.

Conclusion

Regular Hydrochlorothiazide doses (12.5 mg, 25 mg or 50 mg) did not result in a significantly lower recurrence rate than placebo in people with recurring kidney stones.