Introduction

Patients often express concerns about the burden of chronic medication use for stone prevention despite its association with decreased stone recurrence. Fatigue and sexual side effects are among such concerns of patients starting thiazide diuretics. However, it is unknown how the use of thiazides affects the health-related quality of life (HRQOL) of stone formers. We evaluated the effect of thiazides on patients’ stone-related HRQOL.

Methods

Utilizing the previously validated Wisconsin Stone QOL questionnaire (WISQOL), we analyzed cross-sectional data from patients both new to and established in stone prevention who were enrolled at sites participating in the North American Stone Quality of Life Consortium. We compared HRQOL in the domains of social impact, emotional impact, disease impact, and vitality in patients prescribed thiazides against those not using student’s t-test. We performed multivariate linear regression controlling for age, gender, BMI, and number of stone events to confirm the significance of any differences. Additionally, we assessed with univariate and multivariate logistic regression the likelihood of complaints of fatigue and reduced sexual interest/activity between those prescribed and not prescribed thiazides.

Results

1511 stone formers were included (787 M, 724 F), of whom 207 were on a thiazide at study enrollment. Patients prescribed a thiazide had significantly higher scores (better HRQOL) in each domain compared to those not prescribed a thiazide. These differences maintained significance with multivariate analysis (mean domain scores higher by 1.9, 2.3, 2.1, 1.0 points, respectively, all p<0.01). Patients prescribed thiazides were less likely than those not prescribed to report any fatigue in the last 4 weeks (59% vs 68%, p=0.008). Those on thiazides were less likely to report reduced sexual interest/activity (24% vs 31%, p=0.02). On multivariate logistic regression, patients on thiazides were overall 32% less likely to report fatigue, p=0.02, and 33% less likely to report reduced sexual interest/activity, p=0.026, when controlling for the aforementioned factors.

Conclusions

Patients prescribed thiazide diuretics for stone prevention demonstrated better HRQOL compared to patients not prescribed one. Specifically, thiazide use was not associated with fatigue or reduced sexual interest/activity. These findings may provide reassurance to patients being counseled on starting thiazides for medical management of stones.

Funding

None