Thiazide diuretics for preventing calcium oxalate recurrent kidney stones: an updated systematic review, meta-analysis and trial sequential analysis of randomized controlled trials.

Abstract

Introduction: Nephrolithiasis, a prominent urological condition, necessitates effective management. Thiazide diuretics play a crucial role in preventing recurrence, supported by a prior meta-analysis. Guidelines further endorse thiazides for nephrolithiasis in hypercalciuria cases. Despite this knowledge, uncertainties persist in optimizing thiazide prescriptions for hypercalciuric patients. The intent of this study is to offer a comprehensive update on nephrolithiasis management, evaluating thiazide diuretics' role using insights from recent RCTs and trial sequential analysis.

Evidence acquisition: A systematic search was conducted in MEDLINE, Embase, Scopus, Cochrane, Web of Science and Google Scholar. We included only RCTs studies that compared thiazides diuretics and placebo for managing recurrence of nephrolithiasis in patients with hypercalciuria. Our primary outcome of interest was the rate of recurrence of calculi. Secondary outcomes included the 24-hour calciuria and the 24-hour citraturia.

Evidence synthesis: We retrieved 10 articles, encompassing 650 patients in the intervention group and 672 patients in the placebo group. Overall, our findings favor thiazide diuretics, through recurrence rate in patients that received thiazides (RR 0.63; 95% CI 0.49, 0.83; P=0.0007; I²=65%). Also, when analyzing the urinary parameters, there was a lower prevalence of 24-hour calciuria in those patients who underwent treatment with thiazides (MD -40.59; 95% CI -76.39, -4.79; P=0.03; I²=84%), while no difference was found regarding the 24-hour citraturia between groups (MD -29.70; 95% CI -83.02, 23.63; P=0.28; I²=59%).

Conclusions: This comprehensive systematic review, meta-analysis and trial sequential analysis confirms that thiazide diuretics significantly mitigates the risk of nephrolithiasis in patients with hypercalciuria.