- 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.
- 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.
- 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).
- CKD: aHR=1.32; 95% CI, 1.13-1.53.
- ESRD: aHR=1.37; 95% CI, 1.15-1.63.
- Observational design, single measurement.