Paradoxical Anti-diuretic Effects of Thiazide and Thiazide-Like Diuretics in Diabetes Insipidus: A Systematic Review
Abstract
Diabetes insipidus (DI) is a rare endocrine disorder predominantly characterized by polyuria, polydipsia, and dehydration, which can be defined as an excess of 3L of urine excretion in an adult over 24 hours, with the urine osmolality being less than 300 mosm/kg H2O. Increased water loss from the body can lead to significant complications, including death, from severe dehydration. Hence, timely treatment of the disease to prevent and replace the fluid loss should be instituted. Thiazide diuretics are the drugs used and act paradoxically in this particular situation. Thiazides and thiazide-like drugs have shown promising results in reducing the volume of urine output and enhancing urine osmolality in patients with nephrogenic diabetes. The mechanism by which thiazide diuretics are able to cause such a paradoxical effect is not well understood. This systematic review seeks to shed light to the details of the exact mechanism through which thiazides and thiazide-like drugs act in patients with DI, so as to bring positive changes in their overall health status and keep the water loss to a minimum. Completed clinical trials, from January 1965 to January 2025, were included in the systematic review. Risk of bias was evaluated in each of the selected articles. The revised Cochrane risk-of-bias tool for randomized trials (RoB 2) with was used for the two crossover randomized controlled trials (RCTs) and the Risk of Bias In Non-randomized Studies - of Interventions, Version 2…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Metformin as an adjuvant in breast cancer treatment
- Metformin Lysosomal Targeting: A Novel Aspect to Be Investigated for Metformin Repurposing in Neurodegenerative Diseases?
- Aberrant HSF1 signaling activation underlies metformin amelioration of myocardial infarction in mice
- Metformin induces ZFP36 by mTORC1 inhibition in cervical cancer-derived cell lines
- Protein Interaction Network for Identifying Vascular Response of Metformin (Oral Antidiabetic)
- Preventing Long COVID With Metformin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.