BACKGROUND Thiazide diuretics reduce the risk of recurrent kidney calculi in patients with kidney calculi or hypercalciuria. However, whether thiazide diuretics can definitely prevent recurrent kidney calculi remains unclear. We aimed to evaluate the effect and safety of thiazide diuretics on recurrent kidney calculi. METHODS The PubMed, Cochrane Library, and EMBASE databases were systematically searched using the keywords thiazide diuretics and kidney calculi to identify randomized controlled trials (RCTs). The primary outcome was the incidence of recurrent kidney calculi, and the secondary outcome was the 24-h urinary calcium level. The pooled risk ratio (RR), risk difference (RD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated. The evidence quality was graded using the GRADE criteria, and recommendations for recurrent kidney calculus prevention using thiazide diuretics were reassessed. RESULTS Eight RCTs involving 571 patients were included. The pooled RR for the incidence of kidney calculi in the thiazide diuretic groups was 0.44 (95% CI 0.33-0.58, P < 0.0001) compared to that in the placebo and untreated groups; the pooled RD was - 0.23 (95% CI - 0.30 to - 0.16, P < 0.0001). The pooled SMD for the 24-h urinary calcium level was - 18.59 (95% CI - 25.11 to - 12.08, P < 0.0001). The thiazide diuretic groups had a high incidence of adverse reactions and low tolerance. The evidence quality for decrease in kidney calculus incidence using thiazide diuretics was low, while that for the 24-h urinary calcium level decrease among those with recurrent kidney calculi was moderate, and that for the decrease in kidney calculus incidence using short-acting and long-acting thiazide diuretics was low. The overall strength of recommendation for prevention of recurrent renal calculi using thiazide diuretics was not recommended. The subgroup and sensitivity analysis findings were robust. CONCLUSIONS Long-term use of thiazide diuretics reduces the incidence of recurrent renal calculi and 24-h urinary calcium level. However, the benefits are insufficient, and the evidence quality is low. Considering the adverse effects, poor patient compliance, and economic burden of long-term medication, their use in preventing recurrent kidney calculi is not recommended.

中文翻译：

---

噻嗪类利尿剂在预防肾脏结石复发中的应用：系统评价和荟萃分析。

背景技术噻嗪类利尿剂可降低肾结石或高钙尿症患者肾结石复发的风险。但是，噻嗪类利尿剂是否能绝对预防肾结石复发尚不清楚。我们旨在评估噻嗪类利尿剂对复发性肾结石的疗效和安全性。方法使用关键词噻嗪类利尿剂和肾结石系统搜索PubMed，Cochrane图书馆和EMBASE数据库，以鉴定随机对照试验（RCT）。主要结局是复发性肾结石的发生率，次要结局是24小时尿钙水平。计算合并的风险比（RR），风险差异（RD），标准化平均差异（SMD）和95％置信区间（CI）。使用GRADE标准对证据质量进行分级，重新评估了使用噻嗪类利尿剂预防肾脏结石的建议。结果纳入8项RCT，涉及571例患者。与安慰剂组和未治疗组相比，噻嗪类利尿剂组肾脏结石发生率的合并RR为0.44（95％CI 0.33-0.58，P <0.0001）。合并的RD为-0.23（95％CI-0.30至-0.16，P <0.0001）。24小时尿钙水平的汇总SMD为-18.59（95％CI-25.11至-12.08，P <0.0001）。噻嗪类利尿剂组不良反应发生率高，耐受性低。使用噻嗪类利尿剂可降低肾脏结石发生率的证据质量较低，而肾结石复发的患者中24小时尿钙水平下降的证据质量中等，使用短效和长效噻嗪类利尿剂减少肾结石的发生率较低。不推荐使用噻嗪类利尿剂预防肾脏结石复发的总体强度。亚组和敏感性分析的结果是强有力的。结论长期使用噻嗪类利尿剂可降低复发性肾结石的发生率和24小时尿钙水平。但是，收益不足，证据质量很差。考虑到不良反应，患者依从性差以及长期药物治疗的经济负担，不建议将其用于预防肾结石复发。不推荐使用噻嗪类利尿剂预防肾脏结石复发的总体强度。亚组和敏感性分析的结果是强有力的。结论长期使用噻嗪类利尿剂可减少复发性肾结石的发生率和24小时尿钙水平。但是，收益不足，证据质量很差。考虑到不良反应，患者依从性差以及长期药物治疗的经济负担，不建议将其用于预防肾结石复发。不推荐使用噻嗪类利尿剂预防肾脏结石复发的总体推荐强度。亚组和敏感性分析的结果是强有力的。结论长期使用噻嗪类利尿剂可降低复发性肾结石的发生率和24小时尿钙水平。但是，收益不足，证据质量很差。考虑到不良反应，患者依从性差以及长期药物治疗的经济负担，不建议将其用于预防肾结石复发。