title: Thiazide diuretic prophylaxis for kidney stones and the risk of diabetes mellitus.
abstract: OBJECTIVE
  Thiazide diuretics used to treat hypertension are associated with a modest risk of diabetes mellitus. It is unknown if there is a similar risk with kidney stone prevention.
  
  
  METHODS
  We identified and validated incident stone formers in Olmsted County, Minnesota from 1984 to 2011 with manual review of medical records using the Rochester Epidemiology Project. The risk of diabetes mellitus after thiazide therapy was evaluated with and without multivariate adjustment for hypertension, age, gender, race, family history of stones, body mass index and number of stone events.
  
  
  RESULTS
  Among 2,350 incident stone formers with a median followup of 10 years, 332 (14%) were treated with thiazide diuretics at some point after the first stone event and 84 (3.6%) received the thiazide diuretic only for kidney stone prevention. Stone formers who received thiazide diuretics were more likely to be older, have hypertension, have higher body mass index and have more stone events. The incidence of diabetes mellitus at 10 years after the first stone event was 9.2% in the group that received thiazide diuretics vs 4.2% in those who did not (HR 2.91; 95% CI 2.02, 4.20). After multivariate adjustment the risk of diabetes mellitus was attenuated (HR 1.20; 95% CI 0.78, 1.83). The risk of diabetes mellitus among those receiving thiazide diuretics solely for kidney stones was further attenuated (multivariate adjusted HR 0.80; 95% CI 0.28, 2.23).
  
  
  CONCLUSIONS
  Thiazide diuretic use for kidney stone prophylaxis was not associated with a high risk of diabetes mellitus. Larger studies are needed to determine if there is a modest risk of diabetes mellitus with thiazide diuretics.
authors.affiliation: Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
authors.forename: Prince
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: John J
authors.initials: JJ
authors.lastname: Knoedler
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.affiliation: Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
authors.forename: John C
authors.initials: JC
authors.lastname: Lieske
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.affiliation: Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Electronic address: rule.andrew@mayo.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Rule
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007669:Kidney Calculi / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D049993:Sodium Chloride Symporter Inhibitors
keywords: calculi; diabetes mellitus; diuretics; thiazides