Effects of short and long-term indapamide treatments on urinary calcium excretion in patients with calcium oxalate dihydrate urinary stone disease: A pilot study

Abstract

Owing to the low effective dosage of indapamide (1.5 mg/day) and the lack of any severe side-effects, this drug would appear to be a good candidate for use in the control of hypercalciuria. As such, it could prove efficacious in the prevention of recurrent kidney stones that are often associated with this condition.

Effect of diuretics on renal tubular transport of calcium and magnesium

“…Indapamide also reduces urinary Ca 2ϩ excretion in a number of trials, including in stone formers (10,29,50,155). In line with a dual mechanism of action for this compound, the blood pressure lowering effect obtained by acting on both the vasculature and by inhibiting NaCl transport in the DCT could both lead to activation of the renin-angiotensin-aldosterone system (50) and hence stimulate Na ϩ transport in the PT (102).…”

“…Electrolyte measurement in a 24-h urine collection following a single dose of 2.5 mg indapamide showed increased urinary NaCl excretion and reduced urinary Ca 2ϩ excretion, but the total amount of Mg 2ϩ excreted in the urine was not altered (199). In patients with stone disease, 6 or 18 mo of treatment with indapamide, 1.5-mg sustained release formulations, reduced urinary Ca 2ϩ but did not affect urinary Mg 2ϩ excretion (10). Similarly, no effect could be documented on serum Mg 2ϩ levels (10,232).…”

“…In patients with stone disease, 6 or 18 mo of treatment with indapamide, 1.5-mg sustained release formulations, reduced urinary Ca 2ϩ but did not affect urinary Mg 2ϩ excretion (10). Similarly, no effect could be documented on serum Mg 2ϩ levels (10,232). On the basis of the limited amount of data, it is difficult to draw firm conclusions on this; however, the available studies do suggest that indapamide may have a Mg 2ϩ -sparing effect by virtue of its mechanism of action, namely by acting on both the vasculature and the DCT to lower blood pressure.…”

Effects of thiazides and new findings on kidney stones and dysglycemic side effects

“…112,115,116 With respect to urine citrate, no change up to a reduction of 20%-30% has been reported for both indapamide and chlorthalidone compared with baseline. 110,115,117,118 Based on recent trial data, it seems prudent to recommend the use of alkali such as potassium citrate as first-line treatment for pharmacologic recurrence prevention of kidney stones. 23,[119][120][121][122][123][124] In patients with calcium kidney stones that are not responsive, or intolerant to citrate supplementation, potent long-acting thiazides such as chlorthalidone or indapamide may be tried, despite the lack of data showing an advantage of these thiazide-like compounds over HCT for kidney stone recurrence prevention.…”

“…With respect to urine calcium, indapamide at doses of 1.5 or 2.5 mg reduced urine calcium by 20%–55% compared with baseline, 110,113,114 whereas chlorthalidone achieved similar reduction rates with doses of 25–100 mg daily 112,115,116 . With respect to urine citrate, no change up to a reduction of 20%–30% has been reported for both indapamide and chlorthalidone compared with baseline 110,115,117,118 . Based on recent trial data, it seems prudent to recommend the use of alkali such as potassium citrate as first‐line treatment for pharmacologic recurrence prevention of kidney stones 23,119–124 .…”