Verploegen Maartje F A, Nijenhuis Tom
Radboudumc, afd. Nierziekten, Nijmegen.
Contact: Tom Nijenhuis (
Ned Tijdschr Geneeskd. 2023 Nov 1;167:D7754.
Thiazides are widely used to prevent recurrence of calcium-containing kidney stones. However, the recent NOSTONE trial reported no benefit of hydrochlorothiazide on the composite outcome of symptomatic or radiologic recurrence. Higher doses (25 and 50mg daily) resulted in a decrease of radiologic recurrence, but no difference in symptomatic stones. Current guidelines preserve the use of hydrochlorothiazide to patients with overt hypercalciuria, while NOSTONE also included patients without hypercalciuria. This might have underestimated the effect of hydrochlorothiazide. While patients received dietary counseling, results suggest adherence was poor e.g. with respect to oxalate and salt consumption, possibly mitigating a potential beneficial hypocalciuric effect of hydrochlorothiazide. Furthermore, previous studies that did show an effect of thiazides on stone recurrence used higher doses. Thus, while hydrochlorothiazide might not be effective in all patients with calcium-containing kidney stones, it should not be written off, as its efficacy in overt hypercalciuria needs to be further elucidated.
噻嗪类药物被广泛用于预防含钙肾结石的复发。然而，最近的NOSTONE试验报告称，氢氯噻嗪对有症状或影像学复发的复合结局并无益处。较高剂量（每日25毫克和50毫克）可导致影像学复发减少，但对有症状的结石并无差异。当前指南仍保留对明显高钙尿症患者使用氢氯噻嗪，而NOSTONE试验还纳入了无高钙尿症的患者。这可能低估了氢氯噻嗪的效果。虽然患者接受了饮食咨询，但结果表明依从性较差，例如在草酸盐和盐的摄入方面，这可能会减轻氢氯噻嗪潜在的有益的降低尿钙作用。此外，之前确实显示噻嗪类药物对结石复发有作用的研究使用的是更高剂量。因此，虽然氢氯噻嗪可能并非对所有含钙肾结石患者都有效，但不应将其摒弃，因为其在明显高钙尿症中的疗效仍需进一步阐明。
