Abstract
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.
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