Work

Baseline Urinary Calcium and the Efficacy of Thiazide Diuretics for Kidney Stone Prevention

Year: 2026

Type: article

Abstract: PURPOSE: Previous studies have shown that thiazide diuretics' ability to decrease symptomatic stone events depends on the extent to which they reduce urine calcium. However, it remains unknown whether the calcium change from thiazide diuretics depends on the baseline urine calcium level. MATERIALS AND METHODS: Among a cohort of Medicare beneficiaries with a 24-hour urine collection for kidney stone disease processed by Labcorp/Litholink between 2011 and 2018, we identified a subset aged > 18 years newly prescribed a thiazide diuretic who performed a second collection between 30 and 180 days after their initial prescription fill. We then fit multivariable linear regression models to estimate the association between dose of thiazide prescribed and change in urine calcium, stratifying by baseline urine calcium. We compared cumulative incidences of clinical stone events stratified by baseline urine calcium groups within a treated and untreated cohort. RESULTS: < 0.001). CONCLUSIONS: Greater urine calcium reductions after thiazide treatment are observed among those with higher baseline urine calcium, and higher thiazide dose led to a larger reduction. These data are relevant for individualizing thiazide dose for kidney stone prevention.

Source: The Journal of Urology

DOI: 10.1097/ju.0000000000005042