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Urolithiasis

, Volume 41, Issue 4, pp 315–322 | Cite as

Hydrochlorothiazide compared to chlorthalidone in reduction of urinary calcium in patients with kidney stones

  • Dawn F. Wolfgram
  • Vinod Gundu
  • Brad C. Astor
  • R. Allan Jhagroo
Original Paper

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.

Keywords

Urinary calcium Hydrochlorothiazide Chlorthalidone Nephrolithiasis Secondary prevention 

Notes

Acknowledgments

We would like to thank Dr. Stephen Knohl and Dr Amarinder Garcha for collaborating and obtaining the data from the patients at the Upstate Medical Center, Syracuse, NY, USA.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Dawn F. Wolfgram
    • 1
  • Vinod Gundu
    • 4
  • Brad C. Astor
    • 2
    • 3
  • R. Allan Jhagroo
    • 2
  1. 1.Division of Nephrology, Department of MedicineMedical College of Wisconsin and Clement Zablocki Veterans Affairs Medical CenterMilwaukeeUSA
  2. 2.Department of Medicine, Division of NephrologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.Department of MedicineSUNY Upstate Medical UniversitySyracuseUSA

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