Thiazide diuretics may be the most effective empiric therapy to prevent recurrence of urinary stones, investigators reported in an oral presentation at the AUA2021 Virtual Experience.

Their data suggest that thiazides should be considered first for empiric preventative pharmacotherapy when 24-hour urine testing is unavailable, Ryan S. Hsi, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues concluded.

The investigators studied 3211 patients diagnosed with urinary stone disease who did not receive 24-hour urine testing prior to initiating empiric pharmacotherapy and who had at least 3 years of follow-up data. The cohort consisted of 1819 patients (57%) empirically prescribed thiazides and 550 (17%), 639 (20%), and 203 (6%) empirically prescribed allopurinol, alkali citrate, and combination therapy, respectively.

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After controlling for patient factors, including medication adherence and concomitant conditions that increase recurrence risk, thiazide therapy was significantly associated with 32% reduced odds of recurrence compared with allopurinol therapy,

The investigators found no reduction in the odds of recurrence with alkali citrate therapy compared with allopurinol or for combination therapy compared with thiazide monotherapy.

At 3 years of follow-up, the probability of a stone-related event among patients prescribed thiazide therapy was reduced by 6 percentage points compared with those prescribed either alkali citrate or allopurinol, Dr Hsi and colleagues reported.

In a previous study of 10,125 patients diagnosed with kidney stones, Dr Hsi and colleagues found no significant difference in the risk for stone recurrence between patients who received selective pharmacologic therapy guided by 24-hour urine testing and those treated empirically with pharmacotherapy, according to findings published recently in Urology. The investigators said their results suggest a need to identify patients with kidney stones who benefit from 24-hour urine testing. Of the 10,125 patients, 2744 (27%) received selective and 7381 received empiric therapy. The overall frequency of any stone-related event was 11%, and this did not differ significantly between the groups.


Hsi R, Yan P, Crivelli J, Shahinian V, Hollingsworth J. Comparative effectiveness of empiric preventative pharmacologic therapies on stone recurrence among patients with urinary stone disease. Presented at: AUA 2021, held September 10-13, 2021. Abstract PD21-05.

Hsi RS, Yan PL, Goldfarb DS, et al. Comparison of selective versus empiric pharmacologic preventative therapy with kidney stone recurrence. Urology. 2021;149:81-88. doi:10.1016/j.urol.2020.11.054