From the Guidelines
Hydrochlorothiazide should not be stopped in patients with stone formation, as it is actually recommended as a pharmacologic monotherapy to prevent recurrent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce the formation of stones. According to the American College of Physicians guideline 1, thiazide diuretics, such as hydrochlorothiazide, reduce the risk for recurrence of composite calcium stones. The guideline recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent recurrent nephrolithiasis in patients with active disease.
- Key points to consider:
- Thiazide diuretics, citrates, and allopurinol all effectively reduced recurrence of calcium stones, which are the most common type of stone.
- The available evidence evaluated higher doses of thiazides, but the use of lower doses is associated with fewer adverse effects.
- The effectiveness of lower doses of thiazides in preventing stone recurrence compared with higher doses is not known.
- In patients with a history of calcium stones, the benefits of hydrochlorothiazide therapy, including reducing the risk of stone recurrence, should be weighed against the potential risks.
- Patients should increase fluid intake to at least 2-3 liters daily and follow up with urinalysis to monitor for improvement, as recommended by the guideline 1.
From the Research
Stone Formation and Hydrochlorothiazide
- The use of hydrochlorothiazide in patients with stone formation is a topic of interest, with studies investigating its effectiveness in preventing stone recurrence 2, 3, 4.
- A study from 1981 found that low-dose hydrochlorothiazide (50 mg/day) was effective in reducing urinary calcium excretion and stone recurrence in patients with calcium nephrolithiasis 2.
- However, a 2011 study noted that low-dose hydrochlorothiazide (12.5-25 mg/day) was often used for prevention of calcium-containing kidney stones, despite a lack of evidence for its effectiveness at these doses 3.
- Another study from 2011 discussed the treatment and prevention of kidney stones, including the use of thiazide diuretics, but did not specifically address the question of stopping hydrochlorothiazide in stone formation 5.
- A 2021 update article discussed the use of thiazide and thiazide-like diuretics in nephrolithiasis, including their anticalciuric properties and potential side effects, but did not provide a clear answer to the question of stopping hydrochlorothiazide in stone formation 4.
Decision to Stop Hydrochlorothiazide
- The decision to stop hydrochlorothiazide in patients with stone formation should be based on individual patient factors, including the type of stone, underlying medical conditions, and response to treatment.
- There is no clear evidence to suggest that hydrochlorothiazide should be stopped in all patients with stone formation, but rather that its use should be tailored to the individual patient's needs and monitored for effectiveness and potential side effects 2, 3, 4.
- A 2015 review of dietary treatment of urinary risk factors for renal stone formation discussed the importance of individualized treatment approaches, including dietary modifications and medical therapy, but did not specifically address the use of hydrochlorothiazide 6.