Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63(5):1817–1823. doi:10.1046/j.1523-1755.2003.00917.x

    Article  PubMed  Google Scholar 

  2. Scales CD Jr, Smith AC, Hanley JM, Saigal CS (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165. doi:10.1016/j.eururo.2012.03.052

    Article  PubMed  Google Scholar 

  3. Pearle MS, Calhoun EA, Curhan GC (2005) Urologic diseases in America project: urolithiasis. J Urol 173(3):848–857. doi:10.1097/01.ju.0000152082.14384.d7

    Article  PubMed  Google Scholar 

  4. Semins MJ, Matlaga BR (2010) Medical evaluation and management of urolithiasis. Ther Adv Urol 2(1):3–9. doi:10.1177/1756287210369121

    Article  PubMed  CAS  Google Scholar 

  5. Uribarri J, Oh MS, Carroll HJ (1989) The first kidney stone. Ann Intern Med 111(12):1006–1009

    Article  PubMed  CAS  Google Scholar 

  6. Rule AD, Krambeck AE, Lieske JC (2011) Chronic kidney disease in kidney stone formers. Clin J Am Soc Nephrol 6(8):2069–2075. doi:10.2215/CJN.10651110

    Article  PubMed  Google Scholar 

  7. Rule AD, Roger VL, Melton LJ 3rd, Bergstralh EJ, Li X, Peyser PA, Krambeck AE, Lieske JC (2010) Kidney stones associate with increased risk for myocardial infarction. J Am Soc Nephrol 21(10):1641–1644. doi:10.1681/ASN.2010030253

    Article  PubMed  Google Scholar 

  8. Yendt ER, Guay GF, Garcia DA (1970) The use of thiazides in the prevention of renal calculi. Can Med Assoc J 102(6):614–620

    PubMed  CAS  Google Scholar 

  9. Laerum E, Larsen S (1984) Thiazide prophylaxis of urolithiasis. A double-blind study in general practice. Acta Med Scand 215(4):383–389

    Article  PubMed  CAS  Google Scholar 

  10. Ettinger B, Citron JT, Livermore B, Dolman LI (1988) Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not. J Urol 139(4):679–684

    PubMed  CAS  Google Scholar 

  11. Fernandez-Rodriguez A, Arrabal-Martin M, Garcia-Ruiz MJ, Arrabal-Polo MA, Pichardo-Pichardo S, Zuluaga-Gomez A (2006) The role of thiazides in the prophylaxis of recurrent calcium lithiasis. Actas Urol Esp 30(3):305–309

    Article  PubMed  CAS  Google Scholar 

  12. Reilly RF, Peixoto AJ, Desir GV (2010) The evidence-based use of thiazide diuretics in hypertension and nephrolithiasis. Clin J Am Soc Nephrol 5(10):1893–1903. doi:10.2215/CJN.04670510

    Article  PubMed  CAS  Google Scholar 

  13. Vigen R, Weideman RA, Reilly RF (2011) Thiazides diuretics in the treatment of nephrolithiasis: are we using them in an evidence-based fashion? Int Urol Nephrol 43(3):813–819. doi:10.1007/s11255-010-9824-6

    Article  PubMed  CAS  Google Scholar 

  14. ALLHAT Collaborative Research Group (2000) Major cardiovascular events in hypertensive patients randomized to doxazosin vs. chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 283 (15):1967–1975

    Google Scholar 

  15. Flack JM, Cushman WC (1996) Evidence for the efficacy of low-dose diuretic monotherapy. Am J Med 101(3):53S–60S

    Article  PubMed  CAS  Google Scholar 

  16. Flöge J, Johnson RJ, Feehally J (2010) Comprehensive clinical nephrology. Saunders Elsevier, St. Louis

    Google Scholar 

  17. Curhan GC, Taylor EN (2008) 24-h uric acid excretion and the risk of kidney stones. Kidney Int 73(4):489–496. doi:10.1038/sj.ki.5002708

    Article  PubMed  CAS  Google Scholar 

  18. Yendt ER, Cohanim M (1978) Prevention of calcium stones with thiazides. Kidney Int 13(5):397–409

    Article  PubMed  CAS  Google Scholar 

  19. Ernst ME, Carter BL, Goerdt CJ, Steffensmeier JJ, Phillips BB, Zimmerman MB, Bergus GR (2006) Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension 47(3):352–358. doi:10.1161/01.HYP.0000203309.07140.d3

    Article  PubMed  CAS  Google Scholar 

  20. Ernst ME, Carter BL, Zheng S, Grimm RH Jr (2010) Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone: effects on systolic blood pressure and potassium. Am J Hypertens 23(4):440–446. doi:10.1038/ajh.2010.1

    Article  PubMed  CAS  Google Scholar 

  21. Carter BL, Ernst ME, Cohen JD (2004) Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 43(1):4–9. doi:10.1161/01.HYP.0000103632.19915.0E

    Article  PubMed  CAS  Google Scholar 

  22. SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265 (24):3255–3264

    Google Scholar 

  23. Sumiye L, Vivian AS, Frisof KB, Podany EC (1981) Potassium loss associated with hydrochlorothiazide versus chlorthalidone. Clin Ther 4(4):308–320

    PubMed  CAS  Google Scholar 

  24. Dhalla IA, Gomes T, Zhan Y, Nagge J, Persaud N, Hellings C, Mamdami MM, Juurlink DN (2013) Chlorthalidone versus hydrochlorothiazide for treatment of hypertension in older adults. Ann Intern Med 158(6):447–455

    Article  PubMed  Google Scholar 

  25. Zuckerman JM, Assimos DG (2009) Hypocitraturia: pathophysiology and medical management. Rev urol 11(3):134–144

    PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Medical College of Wisconsin and Clement Zablocki Veterans Affairs Medical Center, 5000 West National Ave (CC-111K), Rm 5423A, Milwaukee, WI, 53226, USA

    Dawn F. Wolfgram

  2. Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Brad C. Astor & R. Allan Jhagroo

  3. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Brad C. Astor

  4. Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA

    Vinod Gundu

Authors
  1. Dawn F. Wolfgram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vinod Gundu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brad C. Astor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Allan Jhagroo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dawn F. Wolfgram.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wolfgram, D.F., Gundu, V., Astor, B.C. et al. Hydrochlorothiazide compared to chlorthalidone in reduction of urinary calcium in patients with kidney stones. Urolithiasis 41, 315–322 (2013). https://doi.org/10.1007/s00240-013-0568-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-013-0568-5

Keywords

Search

Navigation