Dataset Information

Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.

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.

SUBMITTER: Alexander RT

PROVIDER: S-EPMC6048667 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.

Alexander R Todd RT McArthur Eric E Jandoc Racquel R Welk Blayne B Fuster Daniel G DG Garg Amit X AX Quinn Robert R RR

Canadian journal of kidney health and disease 20180715

<h4>Background</h4>Thiazide diuretics are commonly prescribed to prevent kidney stones. However, it is unclear whether higher doses confer greater benefit.<h4>Objective</h4>To determine whether lower doses of thiazide diuretics confer a similar protective effect against kidney stone events as higher doses.<h4>Design</h4>Population-based cohort study.<h4>Setting</h4>Linked health administrative databases in Ontario, Canada.<h4>Patients</h4>Older adults newly prescribed a thiazide diuretic between ...[more]

PMID: 30034815

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Project description:BackgroundRisk for acute kidney injury (AKI) in older adults has not been evaluated systematically. We sought to delineate the determinants of risk for AKI in older compared with younger adults.Study designRetrospective analysis of patients hospitalized in July 2000 to September 2008.Setting & participantsWe identified all adult patients admitted to an intensive care unit (n=45,655) in a large tertiary-care university hospital system. We excluded patients receiving dialysis or a kidney transplant prior to hospital admission and patients with baseline creatinine levels ≥ 4mg/dL, liver transplantation, indeterminate AKI status, or unknown age, leaving 39,938 patients.PredictorWe collected data for multiple susceptibilities and exposures, including age, sex, race, body mass, comorbid conditions, severity of illness, baseline kidney function, sepsis, and shock.OutcomesWe defined AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. We examined susceptibilities and exposures across age strata for impact on the development of AKI.MeasurementsWe calculated area under the receiver operating characteristic curve (AUC) for prediction of AKI across age groups.Results25,230 (63.2%) patients were 55 years or older. Overall, 25,120 (62.9%) patients developed AKI (69.2% aged ≥55 years). Examples of risk factors for AKI in the oldest age category (≥75 years) were drugs (vancomycin, aminoglycosides, and nonsteroidal anti-inflammatories), history of hypertension (OR, 1.13; 95% CI, 1.02-1.25), and sepsis (OR, 2.12; 95% CI, 1.68-2.67). Fewer variables remained predictive of AKI as age increased and the model for older patients was less predictive (P<0.001). For the age categories 18 to 54, 55 to 64, 65 to 74, and 75 years or older, AUCs were 0.744 (95% CI, 0.735-0.752), 0.714 (95% CI, 0.702-0.726), 0.706 (95% CI, 0.693-0.718), and 0.673 (95% CI, 0.661-0.685), respectively.LimitationsAnalysis may not apply to non-intensive care unit patients.ConclusionsThe likelihood of developing AKI increases with age; however, the same variables are less predictive for AKI as age increases. Efforts to quantify risk for AKI may be more difficult in older adults.

Dataset Information

Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.

Background

Objective

Design

Setting

Patients

Measurements

Methods

Results

Limitations

Conclusions

Publications

Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study.

Similar Datasets

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