To define the risk of laboratory abnormalities associated with commonly prescribed medications in the context of urinary stone disease.
We used the Veterans Health Administration Corporate Warehouse to identify adults ≥ 18 years with an index episode of urinary stone disease. The development of laboratory abnormalities for those ever versus never on preventive pharmacological therapy were then compared using separate Cox proportional hazards regression models for each laboratory abnormality-drug class combination, adjusting for baseline patient characteristics and time-varying medication use over the study period. To provide a sense for absolute risk, we then used the models to estimate two-year predicted probabilities of developing a laboratory abnormality for each.
Thiazide use was associated with a risk of: hypokalemia (hazard ratio [HR], 2.85; 95% confidence interval [CI], 2.66-3.05), hyponatremia (HR 1.41, 95% CI: 1.24-1.60), and hypercalcemia (HR 2.04, 95% CI: 1.70-2.46). Potassium citrate was associated with a risk of hyperkalemia (HR 1.44, 95% CI: 1.23-1.69). Allopurinol was associated with a risk of cytopenia (HR 1.17, 95% CI: 1.02-1.33). No significant association was observed between thiazide use and hyperglycemia or allopurinol use and transaminitis. The greatest absolute risk was for hypokalemia with thiazide use: a two-year predicted probability of 17.3%.
Preventive pharmacological therapy for urinary stone disease is associated with an increased risk of a variety of laboratory abnormalities, with the greatest absolute risk being hypokalemia with thiazides at over 1 in 6 patients. The study findings provide guidance for laboratory monitoring while on these therapies.
Urology. 2025 Dec 19 [Epub ahead of print]
Matthew S Lee, Raul Garcia Maya, Autumn Valicevic, Mary K Oerline, Sanjeevkumar Patel, John M Hollingsworth, Ryan S Hsi, Vahakn B Shahinian
Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: ., Department of Nephrology, University of Michigan, Department of Veterans Affairs, Ann Arbor, MI., Department of Urology, University of Florida, Gainesville, Florida, USA., Department of Urology, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, University of California, Irvine, Orange, California., Department of Nephrology, University of Michigan, Department of Veterans Affairs, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI.