Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.
- Alexander RT Departments of Pediatrics & Physiology, University of Alberta, Edmonton, Canada.
- McArthur E Institute for Clinical Evaluative Sciences, ON, Canada.
- Jandoc R Institute for Clinical Evaluative Sciences, ON, Canada.
- Welk B Institute for Clinical Evaluative Sciences, ON, Canada.
- Fuster DG Division of Nephrology and Hypertension, Bern University Hospital, Switzerland.
- Garg AX Institute for Clinical Evaluative Sciences, ON, Canada.
- Quinn RR Departments of Medicine and Community Health Sciences, University of Calgary, AB, Canada.
- 2018-07-24
Published in:
- Canadian journal of kidney health and disease. - 2018
English
Background
Thiazide diuretics are commonly prescribed to prevent kidney stones. However, it is unclear whether higher doses confer greater benefit.
Objective
To determine whether lower doses of thiazide diuretics confer a similar protective effect against kidney stone events as higher doses.
Design
Population-based cohort study.
Setting
Linked health administrative databases in Ontario, Canada.
Patients
Older adults newly prescribed a thiazide diuretic between 2003 and 2014 were separated into 2 groups based on daily dose: low dose (⩽12.5 mg hydrochlorothiazide/chlorthalidone, or ⩽1.25 mg indapamide) or high dose.
Measurements
The primary outcome was time to a kidney stone event, using diagnosis and procedure codes. A secondary outcome was kidney stone surgery.
Methods
An association between thiazide diuretic dose and a kidney stone event was estimated using Cox proportional hazards regression.
Results
A total of 536 of 105 239 patients (0.51%) experienced a kidney stone event. We did not detect a difference in kidney stone risk in the high-dose relative to the low-dose group (adjusted hazard ratio, 1.10; 95% confidence interval, 0.93-1.31). Results were similar when analysis was restricted to the more specific outcome of kidney stone surgery. Neither a history of prior kidney stones nor the type of thiazide diuretic modified the effect of diuretic dose on outcome.
Limitations
Patients were >65 years old and we were unable to adjust for some potential confounders such as dietary factors.
Conclusions
Lower dose thiazide diuretics appear to confer a similar protective effect as higher dose thiazides against the development of kidney stones.
Thiazide diuretics are commonly prescribed to prevent kidney stones. However, it is unclear whether higher doses confer greater benefit.
Objective
To determine whether lower doses of thiazide diuretics confer a similar protective effect against kidney stone events as higher doses.
Design
Population-based cohort study.
Setting
Linked health administrative databases in Ontario, Canada.
Patients
Older adults newly prescribed a thiazide diuretic between 2003 and 2014 were separated into 2 groups based on daily dose: low dose (⩽12.5 mg hydrochlorothiazide/chlorthalidone, or ⩽1.25 mg indapamide) or high dose.
Measurements
The primary outcome was time to a kidney stone event, using diagnosis and procedure codes. A secondary outcome was kidney stone surgery.
Methods
An association between thiazide diuretic dose and a kidney stone event was estimated using Cox proportional hazards regression.
Results
A total of 536 of 105 239 patients (0.51%) experienced a kidney stone event. We did not detect a difference in kidney stone risk in the high-dose relative to the low-dose group (adjusted hazard ratio, 1.10; 95% confidence interval, 0.93-1.31). Results were similar when analysis was restricted to the more specific outcome of kidney stone surgery. Neither a history of prior kidney stones nor the type of thiazide diuretic modified the effect of diuretic dose on outcome.
Limitations
Patients were >65 years old and we were unable to adjust for some potential confounders such as dietary factors.
Conclusions
Lower dose thiazide diuretics appear to confer a similar protective effect as higher dose thiazides against the development of kidney stones.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1177/2054358118787480
- PMID 30034815
- Persistent URL
- https://sonar.ch/global/documents/132164
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