Journal Article Ppublish
PubMed: 40063114 DOI: 10.2215/CJN.0000000659
Hydrochlorothiazide and Bone Mineral Density in Patients with Kidney Stones: Post Hoc Analysis of the NOSTONE Trial.
Clin J Am Soc Nephrol 20(5):706-718
Authors: Andreas Christe, Elias Primetis, Grazia M Cereghetti, Dionysios Drakopoulos, Nasser A Dhayat, Olivier Bonny, Alexander Ritter, Nilufar Mohebbi, Nicolas Faller, Lisa Pellegrini, Giulia Bedino, Reto M Venzin, Philipp Grosse, Carina Hüsler, Irene Koneth, Christian Bucher, Rosaria Del Giorno, Luca Gabutti, Michael Mayr, Urs Odermatt, Florian Buchkremer, Thomas Ernandez, Catherine Stoermann-Chopard, Daniel Teta, Luca Tamò, Sven Trelle, Beat Roth, Matteo Bargagli, Daniel G Fuster
Affiliations
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Nephrology and Dialysis Care Center, B. Braun Medical Care AG, Hochfelden, Zürich, Switzerland.
- Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
- Service of Nephrology, Fribourg State Hospital and University of Fribourg, Fribourg, Switzerland.
- Department of Nephrology, University Hospital Zürich, Zürich, Switzerland.
- Department of Nephrology, Regional Hospital Lugano, Lugano, Switzerland.
- Department of Nephrology, Cantonal Hospital Graubünden, Chur, Switzerland.
- Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
- Department of Internal Medicine, Regional Hospital Bellinzona, Bellinzona, Switzerland.
- Medical Outpatient Department, University Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Nephrology, Cantonal Hospital Luzern, Luzern, Switzerland.
- Division of Nephrology, Dialysis and Transplantation, Cantonal Hospital Aarau, Aarau, Switzerland.
- Department of Nephrology, HUG, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
- Service de Nephrology, Centre Hospitalier du Valais Romand, CHVR, Sion, Switzerland.
- Department of Clinical Research, University of Bern, Bern, Switzerland.
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND
Low bone mass and fractures are common among kidney stone formers, yet it remains unclear whether thiazides can help preserve bone mass. We aimed to evaluate the effectiveness of a range of hydrochlorothiazide (HCTZ) doses compared to a placebo on bone mineral density (BMD) over a three-year period.
METHODS
This post-hoc analysis was conducted on data from the NOSTONE trial, a multicenter, randomized, controlled study. A total of 416 adults with recurrent calcium stones participated in the study, receiving either placebo or HCTZ at doses of 12.5 mg, 25 mg or 50 mg daily. BMD was measured using computed tomography (CT) at the T12-L3 vertebrae both at baseline and the end of the study.
RESULTS
Over a median follow-up period of 2.92 years, the mean BMD decreased by 6.4±15.7 Hounsfield Units (HU) in the placebo group, 5.1±15.1 HU in the 12.5 mg HCTZ group (β coefficient vs placebo, 0.37 HU, 95% CI -1.74; 2.47, p = 0.73), 4.1±16.3 HU in the 25 mg HCTZ group (β 0.93 HU, 95% CI -1.34; 3.19, p = 0.42), and 4.8±15.9 HU in the 50 mg HCTZ group (β 0.70 HU, 95% CI -1.45; 2.85, p = 0.52). No association was observed between HCT dose and BMD at the end of the study (p = 0.43). The results were confirmed in sensitivity analyses for eGFR, urine calcium, net gastrointestinal alkali absorption, body mass index (BMI), in subgroup and in per-protocol analyses.
CONCLUSIONS
In patients with recurrent calcium kidney stones, loss of BMD was similar in patients receiving HCTZ at a dose of 12.5 mg, 25 mg, or 50 mg, or placebo once daily.
MeSH
Kidney Diseases, Kidney Calculi, Hydrochlorothiazide, Kidney, Nephrology, Calcium, Bone Density
Cited by
- Kidney stone disease: risk factors, pathophysiology and management. Nat Rev Nephrol, 2025