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NEPHROLOGY

Effect of Indapamide on Urinary Calcium Excretion in Patients With and Without Urinary Stone Disease

Assistant Professor, Faculty of Medicine, Department of Urology, Yuzuncu Yil University, Van, Turkey

Cevat Topal, MD

Nephrologist, Trabzon State Hospital, Trabzon, Turkey

Reha Erkoc, MD

Associate Professor, Faculty of Medicine, Chief of Nephrology Department, Yuzuncu Yil University

Hayriye Sayarlioglu, MD

Assistant Professor, Faculty of Medicine, Department of Nephrology, Yuzuncu Yil University

Saban Can, MD

Resident, Faculty of Medicine, Department of Urology, Yuzuncu Yil University

Yuksel Yilmaz, MD

Assistant Professor, Faculty of Medicine, Department of Urology, Yuzuncu Yil University

Ekrem Dogan, MD

Nephrology Fellow, Faculty of Medicine, Department of Urology, Yuzuncu Yil University

Ekrem Algun, MD

Associate Professor, Endocrinologist, Trabzon State Hospital

Hasan Gonulalan, MD

Resident, Faculty of Medicine, Department of Urology, Yuzuncu Yil University

Reprints: Dr. Ceylan, Yuzuncu Yil University, Arastirma Hastanesi Van, Turkey, 65200, fax 90 432 212 167, drceylan26{at}yahoo.com

BACKGROUND: Indapamide is an antihypertensive agent similar to thiazides, but with some different effects. Thiazide and thiazide-like diuretics are useful in preventing recurrent urinary stone formation due to their hypocalciuric effects.

OBJECTIVE: To determine the hypocalciuric and other effects on certain laboratory parameters of indapamide 1.5 mg in different patient groups.

METHODS: Four groups of patients recruited from urology and nephrology outpatient departments were experiencing non-hypercalciuric urinary stone disease (group 1), idiopathic hypercalciuria (group 2), urinary stone disease with hypercalciuria (group 3), and essential hypertension (group 4). In all patients, fasting serum uric acid, calcium, sodium, potassium, cholesterol, triglyceride, parathyroid hormone (PTH) values, and morning second-spot urine calcium and creatinine levels were assessed before and 8 weeks after treatment with indapamide.

RESULTS: Urinary calcium excretion was reduced significantly in all groups: group 1 from 0.10 ± 0.02 to 0.07 ± 0.03 (mean ± SD; 30% reduction; p < 0.001), group 2 from 0.30 ± 0.15 to 0.15 ± 0.10 (50% reduction; p < 0.001), group 3 from 0.35 ± 0.15 to 0.20 ± 0.10 (43% reduction; p < 0.001), and group 4 from 0.10 ± 0.03 to 0.08 ± 0.02 (20% reduction; p < 0.0010). These results should be interpreted with caution since no control group was included in this study. Mean serum uric acid and triglyceride levels were significantly increased, and mean PTH and potassium levels and diastolic and systolic blood pressure were significantly decreased in all groups. Few temporary adverse effects, such as dizziness and fatigue, were noticed and none of them caused discontinuation of treatment.

CONCLUSIONS: Indapamide 1.5 mg/day is effective in decreasing calciuria in patients with non-hypercalciuric urinary stone disease, idiopathic hypercalciuria, urinary stone disease with hypercalciuria, and essential hypertension. This could be achieved with few adverse effects similar to those of thiazides and indapamide 2.5 mg. Indapamide decreased the PTH levels in all groups. Long-term clinical benefits of these effects should be evaluated prospectively with further randomized studies.

Key Words: hypercalciuria, hypertension, indapamide, urinary stone disease

Published Online, April 19, 2005. www.theannals.com, DOI 10.1345/aph.1E544

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