ArticleKidney medicine2025
Comparison of Thiazide Versus Alkali for Kidney Stone Recurrence Among Individuals With Hypocitraturia and High Urine pH.
Article in Kidney medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Rationale & Objective: To compare symptomatic stone recurrence among individuals with low urinary citrate and high urine pH prescribed thiazides versus alkali. Study Design: Retrospective cohort study. Setting & Participants: Among Medicare beneficiaries with a 24-hour urine collection obtained between 2010 and 2019, individuals with hypocitraturia (≤300 mg/d for men and ≤350 mg/d for women) and high urine pH (>6.3) did not previously receive thiazides or alkali. Exposures: Receipt of thiazide or alkali therapy within 6 months after the urine collection. Outcomes: The incidence of a subsequent symptomatic stone event (ie, an emergency department visit, hospitalization, or surgery). Analytical Approach: Multivariable Cox modeling, adjusting for demographic and baseline 24-hour urine output parameters. Results: Among 1,270 individuals with a mean age of 62.8 years, 68% women, and a median 3.0-year follow-up, we identified 107 and 1,163 individuals receiving thiazides and alkali, respectively. Comparing those who received thiazides versus alkali, there were respective baseline differences in mean 24-hour urinary citrate levels (195 vs 171 mg/d, Limitations: Missing data, miscoding, and residual confounding. Conclusions: Compared with alkali, thiazides are associated with a reduction in symptomatic stone events. These data suggest that a trial is warranted to compare their effectiveness in patients with alkaline urine.
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