Effect of indapamide on urinary calcium excretion in patients with and without urinary stone disease.
BACKGROUND
Indapamide is an antihypertensive agent similar to thiazides, but with some different effects. Thiazide and thiazide-like diuretics are useful in preventing recurrent urinary stone formation due to their hypocalciuric effects.


OBJECTIVE
To determine the hypocalciuric and other effects on certain laboratory parameters of indapamide 1.5 mg in different patient groups.


METHODS
Four groups of patients recruited from urology and nephrology outpatient departments were experiencing non-hypercalciuric urinary stone disease (group 1), idiopathic hypercalciuria (group 2), urinary stone disease with hypercalciuria (group 3), and essential hypertension (group 4). In all patients, fasting serum uric acid, calcium, sodium, potassium, cholesterol, triglyceride, parathyroid hormone (PTH) values, and morning second-spot urine calcium and creatinine levels were assessed before and 8 weeks after treatment with indapamide.


RESULTS
Urinary calcium excretion was reduced significantly in all groups: group 1 from 0.10 +/- 0.02 to 0.07 +/- 0.03 (mean +/-SD; 30% reduction; p < 0.001), group 2 from 0.30 +/- 0.15 to 0.15 +/- 0.10 (50% reduction; p < 0.001), group 3 from 0.35 +/- 0.15 to 0.20 +/- 0.10 (43% reduction; p < 0.001), and group 4 from 0.10 +/- 0.03 to 0.08 +/- 0.02 (20% reduction; p < 0.0010). These results should be interpreted with caution since no control group was included in this study. Mean serum uric acid and triglyceride levels were significantly increased, and mean PTH and potassium levels and diastolic and systolic blood pressure were significantly decreased in all groups. Few temporary adverse effects, such as dizziness and fatigue, were noticed and none of them caused discontinuation of treatment.


CONCLUSIONS
Indapamide 1.5 mg/day is effective in decreasing calciuria in patients with non-hypercalciuric urinary stone disease, idiopathic hypercalciuria, urinary stone disease with hypercalciuria, and essential hypertension. This could be achieved with few adverse effects similar to those of thiazides and indapamide 2.5 mg. Indapamide decreased the PTH levels in all groups. Long-term clinical benefits of these effects should be evaluated prospectively with further randomized studies.
Ceylan
Kadir
K
Faculty of Medicine, Department of Urology, Yuzuncu Yil University, Van, Turkey. drceylan26@yahoo.com
Topal
Cevat
C
Erkoc
Reha
R
Sayarlioglu
Hayriye
H
Can
Saban
S
Yilmaz
Yuksel
Y
Dogan
Ekrem
E
Algun
Ekrem
E
Gonulalan
Hasan
H
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002118:Calcium / Q000097:blood / Q000652:urine*; D002128:Calcium Metabolism Disorders / Q000652:urine; D003404:Creatinine / Q000652:urine; D003692:Delayed-Action Preparations; D004244:Dizziness / Q000139:chemically induced; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000652:urine; D007190:Indapamide / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011188:Potassium / Q000097:blood; D014012:Tinnitus / Q000139:chemically induced; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood; D014545:Urinary Calculi / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine
D000959:Antihypertensive Agents; D003692:Delayed-Action Preparations; D014280:Triglycerides; D014527:Uric Acid; D003404:Creatinine; D007190:Indapamide; D011188:Potassium; D002118:Calcium