title: Hydrochlorothiazide compared to chlorthalidone in reduction of urinary calcium in patients with kidney stones.
abstract: Prevention of recurrent calcium stone disease includes treatment with thiazide and thiazide-type diuretics to reduce urinary calcium (UCa) levels, with the reduction in UCa correlating with risk of stone recurrence. There has been a recent trend of using lower doses of these medications and change from chlorthalidone (CTL) use to hydrochlorothiazide (HCTZ) use. It is unknown whether low doses of HCTZ are effective in lowering UCa levels to target levels. We hypothesize that HCTZ is associated with less reduction in UCa than is CTL when comparing currently used doses. Retrospective observational study of stone-formers was seen in metabolic stone clinic during a 3 years period. Data included patient demographics, co-morbidities, and 24 h urine electrolyte composition. Primary outcome was the change in 24 h UCa. 322 patients were identified with 112 meeting criteria and used in analysis. The majority were placed on HCTZ (n = 42) or CTL (n = 47) 25 mg QD. Patients on CTL 25 mg had a greater reduction in UCa (164 mg; 41 %) than those on HCTZ (85 mg; 21 %), p = 0.01. Neither CTL nor HCTZ at 12.5 mg QD significantly lowered UCa. There was a decrease in serum [K] of 0.5 Meq/L (p = 0.001) in patients on CTL 25 mg daily, but no significant difference in severe hypokalemia or arrhythmia compared to HCTZ. Our data show that CTL is associated with greater reduction in 24 h UCa compared to similarly dosed HCTZ.
authors: Division of Nephrology, Department of Medicine, Medical College of Wisconsin and Clement Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53226, USA. dwolfgram@mcw.edu
authors: Dawn F
authors: DF
authors: Wolfgram
authors: Vinod
authors: V
authors: Gundu
authors: Brad C
authors: BC
authors: Astor
authors: R Allan
authors: RA
authors: Jhagroo
mesh_terms: D002118:Calcium / Q000652:urine*; D002752:Chlorthalidone / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D007669:Kidney Calculi / Q000188:drug therapy* / Q000517:prevention & control / Q000652:urine*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D004232:Diuretics; D006852:Hydrochlorothiazide; D002752:Chlorthalidone; D002118:Calcium
references: Int Urol Nephrol. 2011 Sep;43(3):813-9
references: 20737209
references: Rev Urol. 2009 Summer;11(3):134-44
references: 19918339
references: Clin J Am Soc Nephrol. 2010 Oct;5(10):1893-903
references: 20798254
references: Hypertension. 2004 Jan;43(1):4-9
references: 14638621
references: Actas Urol Esp. 2006 Mar;30(3):305-9
references: 16749588
references: Clin J Am Soc Nephrol. 2011 Aug;6(8):2069-75
references: 21784825
references: JAMA. 1991 Jun 26;265(24):3255-64
references: 2046107
references: Ther Adv Urol. 2010 Feb;2(1):3-9
references: 21789078
references: Am J Hypertens. 2010 Apr;23(4):440-6
references: 20111008
references: Ann Intern Med. 1989 Dec 15;111(12):1006-9
references: 2688503
references: Clin Ther. 1981;4(4):308-20
references: 7332917
references: Am J Med. 1996 Sep 30;101(3A):53S-60S
references: 8876475
references: Hypertension. 2006 Mar;47(3):352-8
references: 16432050
references: J Urol. 2005 Mar;173(3):848-57
references: 15711292
references: Acta Med Scand. 1984;215(4):383-9
references: 6375276
references: J Am Soc Nephrol. 2010 Oct;21(10):1641-4
references: 20616170
references: Kidney Int. 1978 May;13(5):397-409
references: 351268
references: Ann Intern Med. 2013 Mar 19;158(6):447-55
references: 23552325
references: J Urol. 1988 Apr;139(4):679-84
references: 3280829
references: Eur Urol. 2012 Jul;62(1):160-5
references: 22498635
references: Kidney Int. 2008 Feb;73(4):489-96
references: 18059457
references: Kidney Int. 2003 May;63(5):1817-23
references: 12675858
references: JAMA. 2000 Apr 19;283(15):1967-75
references: 10789664
references: Can Med Assoc J. 1970 Mar 28;102(6):614-20
references: 5437394