Use of thiazide diuretics for the prevention of recurrent kidney calculi: a systematic review and meta-analysis

Abstract

Background: Thiazide diuretics reduce the risk of recurrent kidney calculi in patients with kidney calculi or hypercalciuria. However, whether thiazide diuretics can definitely prevent recurrent kidney calculi remains unclear. We aimed to evaluate the effect and safety of thiazide diuretics on recurrent kidney calculi. Methods:The PubMed, Cochrane Library, and EMBASE databases were systematically searched using the keywords thiazide diuretics and kidney calculi to identify randomized controlled trials (RCTs). The primary outcome was the incidence of recurrent kidney calculi, and the secondary outcome was the 24-h urinary calcium level. The pooled risk ratio (RR), risk difference (RD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated. The evidence quality was graded using the GRADE criteria, and recommendations for recurrent kidney calculus prevention using thiazide diuretics were reassessed.Results: Eight RCTs involving 571 patients were included. The pooled RR for the incidence of kidney calculi in the thiazide diuretic groups was 0.44 (95% CI 0.33-0.58, P < 0.0001) compared to that in the placebo and untreated groups; the pooled RD was − 0.23 (95% CI − 0.30 to − 0.16, P < 0.0001). The pooled SMD for the 24-h urinary calcium level was − 18.59 (95% CI − 25.11 to − 12.08, P < 0.0001). The thiazide diuretic groups had a high incidence of adverse reactions and low tolerance. The evidence quality for decrease in kidney calculus incidence using thiazide diuretics was low, while that for the 24-h urinary calcium level decrease among those with recurrent kidney calculi was moderate, and that for the decrease in kidney calculus incidence using short-acting and long-acting thiazide diuretics was low. The overall strength of recommendation for prevention of recurrent renal calculi using thiazide diuretics was not recommended. The subgroup and sensitivity analysis findings were robust. Conclusions:Long-term use of thiazide diuretics reduces the incidence of recurrent renal calculi and 24-h urinary calcium level. However, the benefits are insufficient, and the evidence quality is low. Considering the adverse effects, poor patient compliance, and economic burden of long-term medication, their use in preventing recurrent kidney calculi is not recommended.

Network pharmacology and experimental validation to elucidate the pharmacological mechanisms of Bushen Huashi decoction against kidney stones

“…Kidney stones are a common and frequently-occurring disease of the urinary system, and their incidence increases annually ( 31 ). According to the most recent epidemiological study conducted in China, kidney stones are prevalent in approximately 5.8% of the population ( 32 ).…”

The current status of preventive measures for urinary calculi in children

“…It is worth noting that a meta-analysis of 8 randomized controlled trials showed that the long-term use of thiazide diuretics for the prevention of stone recurrence is not recommended due to poor compliance, multiple side effects, and economic burden. 63 This also suggests that the long-term prophylactic use of hydrochlorothiazide is not recommended for children with non hypercalciuria or high-risk recurrent calcium stones in the prevention of calculus in children. At the same time, attention should be given to the occurrence of adverse events when taking this drug in children with hypercalciuria, recurrent calcium stones, or high-risk first calculi.…”

Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study

“…In some studies, thiazide has been used in idiopathic hypercalciuria [ 19 ]. Li et al reported that the long-term use of thiazide diuretics reduces the incidence of recurrent renal calculi and the 24-h urinary calcium level [ 20 ]. By reducing calcium loss, the bone density and calcium within bones increase.…”