Mp26-15 Associations Between Thiazide Dosage and Urinary Calcium Change With Subsequent Kidney Stone Events

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP26)1 May 2024MP26-15 ASSOCIATIONS BETWEEN THIAZIDE DOSAGE AND URINARY CALCIUM CHANGE WITH SUBSEQUENT KIDNEY STONE EVENTS Ryan Hsi, Phyllis Yan, Kevin Smith, Sara Best, John Asplin, Joseph Crivelli, Naim Maalouf, Vahakn Shahinian, and John Hollingsworth Ryan HsiRyan Hsi , Phyllis YanPhyllis Yan , Kevin SmithKevin Smith , Sara BestSara Best , John AsplinJohn Asplin , Joseph CrivelliJoseph Crivelli , Naim MaaloufNaim Maalouf , Vahakn ShahinianVahakn Shahinian , and John HollingsworthJohn Hollingsworth View All Author Informationhttps://doi.org/10.1097/01.JU.0001009408.66023.77.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The conflicting results of thiazide trials for preventing kidney stone recurrence may be explained by low dosages prescribed, poor medication adherence, and short follow-up. The purpose of this study was to examine the associations between thiazide dose and changes in urinary parameters, as well as subsequent symptomatic stone events. METHODS: Using Medicare claims from a cohort of beneficiaries who had a 24-hour urine collection processed by Litholink between January 2011 and June 2018, we identified a subset aged ≥18 years who had a prescription fill for a thiazide agent within the 6 months that followed their initial 24-hour urine collection and a follow-up collection 30 to 180 days after their first prescription fill. We characterized beneficiaries as receiving a low, medium, or high dose of a thiazide, and we compared their urinary changes between collections in urinary calcium, citrate, and sodium. We evaluated for an association between changes in urine parameters and the cumulative incidence of an emergency department visit, hospitalization, or surgery for stones from 6 up to 36 months of receiving a thiazide. RESULTS: Overall, the cohort included 706 beneficiaries who were 46% female, 95% white, with mean age 68 (SD 8), mean baseline calcium 322mg/day (SD 115) and 69%, 24%, and 7% receiving HCTZ, chlorthalidone, and indapamide, respectively. After adjusting for sociodemographic factors, comorbidities, baseline calcium, medication class, and adherence, the respective percentage changes in daily excretion by low, medium, and high dosage were -19%, -23%, and -27% for calcium (see Figure 1, ptrend<0.05); and 3%, 12%, -19% for citrate (ptrend<0.01). No significant dose associations were observed for urinary sodium, or supersaturations of calcium oxalate or calcium phosphate. Beneficiaries with a greater reduction in urinary calcium had lower incidences of subsequent stone events (1st tertile, 24.4% versus 3rd tertile, 15.4%, ptrend=0.03) by 36 months. No other significant differences in outcomes were observed with changes in urinary supersaturations of calcium oxalate or calcium phosphate. CONCLUSIONS: Higher thiazide doses are associated with greater reductions in urinary calcium, which in turn are associated with lower incidences of subsequent stone events. Download PPT Source of Funding: Supported by NIH R01DK121709 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e419 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ryan Hsi More articles by this author Phyllis Yan More articles by this author Kevin Smith More articles by this author Sara Best More articles by this author John Asplin More articles by this author Joseph Crivelli More articles by this author Naim Maalouf More articles by this author Vahakn Shahinian More articles by this author John Hollingsworth More articles by this author Expand All Advertisement PDF downloadLoading ...