Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.

Alexander, R Todd; McArthur, Eric; Jandoc, Racquel; Welk, Blayne; Fuster, Daniel G.; Garg, Amit X; Quinn, Robert R (2018). Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study. Canadian journal of kidney health and disease, 5, p. 2054358118787480. Sage 10.1177/2054358118787480

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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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension

UniBE Contributor:

Fuster, Daniel Guido


600 Technology > 610 Medicine & health








Daniel Guido Fuster

Date Deposited:

21 Aug 2018 16:02

Last Modified:

24 Oct 2019 16:30

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

dose hydrochlorothiazide kidney stones thiazide diuretics




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