CRIC: high urinary oxalate tied to CKD progression, ESRD

  • Waikar SS & al.
  • JAMA Intern Med
  • 4 Mar 2019

  • International Clinical Digest
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Takeaway

  • High urinary excretion of oxalate is tied to an increased risk for chronic kidney disease (CKD) progression and end-stage renal disease (ESRD).

Why this matters

  • The potentially toxic terminal metabolite is renally excreted.
  • High levels have previously been established as a cause of renal failure in rare genetic diseases, notes an accompanying commentary.

Study design

  • Multicenter prospective cohort study of 3123 patients with stage II-IV CKD (mean age, 59.1 years; 45.3% women; 45.6% white) from the Chronic Renal Insufficiency Cohort (CRIC) study.
  • CKD progression defined as incident ESRD or 50% drop in estimated glomerular filtration rate (eGFR).
  • Funding: NIH, others.

Key results

  • Mean eGFR on 24-hour urine collection, 42.9 mL/minute/1.73 m2.
  • Median urinary oxalate excretion, 18.6 mg/24 hours.
  • Urinary oxalate excretion was inversely associated with eGFR (r=−0.13; P<.001 and positively associated with proteinuria>r=0.22; P<.001>
  • 24.1% of patients developed ESRD and 30.1% had CKD progression over 22,318 person-years of follow-up.
  • Highest quintile (Q5) of oxalate excretion (≥27.8 mg/24 hours) vs Q1 (
  • 33% higher risk for CKD progression (aHR=1.33; P=.003).
  • 45% higher risk for ESRD (aHR=1.45; P=.008).
  • Association was nonlinear, with a threshold effect observed at Q3-5 vs Q1-2:
    • CKD: aHR=1.32; 95% CI, 1.13-1.53.
    • ESRD: aHR=1.37; 95% CI, 1.15-1.63.
  • Limitations

    • Observational design, single measurement.

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