Plasma oxalate levels rise in hemodialysis patients despite increased oxalate removal.

Costello, J.; Sadovnic, Marc J.; Cottington, Eric

doi:10.1681/asn.v1121289

Cited by 45 publications

(6 citation statements)

References 29 publications

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“…In accordance with previous results, the present study demonstrated that UOx excretion or overall oxalate removal levels in all PD patients were within reference intervals for healthy subjects and similar to the previously reported average of UOx excretion in ESKD patients (3,5,6,8,13,35). Nonetheless, the levels of urine output in the participants of the present study were at least four times lower than those of healthy subjects (2,35), meaning that PD patients had hyperoxaluria.…”

Section: Discussionsupporting

confidence: 93%

“…The accumulation of oxalate is associated with oxidative stress and systemic inflammation (1, 8, 9), high cardiovascular risk (9-11), and increased mortality rate (1, 11) in patients with kidney stones and ESKD. Nevertheless, little evidence is available on oxalate balance in ESKD patients in general and peritoneal dialysis (PD) patients in particular; almost all scientific data on this issue were published during the 1980s and 1990s (6,(12)(13)(14).Worldwide, PD is a key element of kidney replacement therapy (15-17). Nonetheless, peritonitis remains one of the major challenges associated with severe clinical complications of PD despite technological advances (17,18).…”

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confidence: 99%

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confidence: 99%

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Oxalate Balance in Peritoneal Dialysis Patients: A Potential Role of Dialysis-related Peritonitis

Stepanova

Korol

Lebid

et al. 2022

In Vivo

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Background: Little evidence is available on oxalate balance in peritoneal dialysis (PD) patients. Patients and Methods: We performed a cross-sectional observational pilot study with 62 adult PD patients to document oxalate balance and explore its association with PD-related peritonitis. Plasma oxalate concentration, levels of oxalate excretion in 24-h urine, and peritoneal dialysis effluent were evaluated. The peritoneal oxalate transport status and renal and peritoneal oxalate clearances were calculated according to the PD-related peritonitis history. Results: PD patients with a history of peritonitis had a statistically significantly lower peritoneal oxalate clearance, daily peritoneal oxalate excretion, and overall oxalate removal rate compared with the peritonitis-free PD patients. They had a 4-fold risk of plasma oxalic acid increase, and even a single episode of dialysis-related peritonitis resulted in plasma oxalate elevation. Conclusion: Peritoneal oxalate clearance plays an important role in oxalate balance in PD patients and, therefore, dialysis-related peritonitis is a significant predictor for hyperoxalemia. Further well-designed clinical trials need to be undertaken before the association between peritonitis and oxalate balance in PD patients is more clearly understood.Oxalate is an ionized form of a potentially toxic oxalic acid formed from endogenously synthesized and exogenously ingested oxalates (1, 2). In physiological conditions, the bulk of circulating oxalate (90-95%) is excreted through the kidneys, whereas the remainder (5-10%) through the terminal parts of the small intestine and colon (1-4). A decline in kidney function leads to decreased oxalate clearance and, ultimately, hyperoxalemia in end-stage kidney disease (ESKD) (1, 5-7). The accumulation of oxalate is associated with oxidative stress and systemic inflammation (1, 8, 9), high cardiovascular risk (9-11), and increased mortality rate (1, 11) in patients with kidney stones and ESKD. Nevertheless, little evidence is available on oxalate balance in ESKD patients in general and peritoneal dialysis (PD) patients in particular; almost all scientific data on this issue were published during the 1980s and 1990s (6,(12)(13)(14).Worldwide, PD is a key element of kidney replacement therapy (15-17). Nonetheless, peritonitis remains one of the major challenges associated with severe clinical complications of PD despite technological advances (17,18). Detrimental effects of dialysis-related peritonitis on the characteristics of peritoneal transport and the alterations of the peritoneal membrane have been documented (19-21). However, the potential effect of dialysis-related peritonitis on oxalate balance in PD patients has never been evaluated before. We hypothesized that the alteration of the peritoneal membrane due to dialysis-related peritonitis could decrease the peritoneal clearance of oxalate and, consequently, its removal levels. To test this hypothesis, the present study aimed to define oxalate balance and explore its association with dia...

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Section: Discussionsupporting

confidence: 93%

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confidence: 99%

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confidence: 99%

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Oxalate Balance in Peritoneal Dialysis Patients: A Potential Role of Dialysis-related Peritonitis

Stepanova

Korol

Lebid

et al. 2022

In Vivo

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“…In one report, three sessions of hemodialysis removed on average of 380 mg of oxalate, although dialyzability could not be estimated [ 131 ]. From studies in dialysis-dependent CKD patients with primary or secondary oxalosis, oxalate clearance surpasses 150 mL/min with hemodialysis and hemodiafiltration [ 301 , 303 – 305 ], which is at least 300% more than the kidney elimination capacity [ 292 , 297 ]. Oxalate clearance in peritoneal dialysis is consistently less than 8 mL/min [ 139 , 293 , 295 , 296 , 303 ].…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

et al. 2023

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Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid–base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong (“we recommend”) or weak/conditional (“we suggest”), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8–12 mmol/L or anion gap 23–27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.

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“…Although moderate doses of vitamin C supplementation (up to 1 g/d) are considered safe, vitamin C supplementation is not exempt of potential drawbacks such as oxalosis, of which its appearance would largely depend on initial (pre-intervention) vitamin C status [ 51 , 52 ]. To the best of our knowledge, previous studies (in different clinical settings) have performed randomized supplementation of fixed doses of vitamin C, despite initial vitamin C status.…”

Section: Discussionmentioning

confidence: 99%

Plasma Vitamin C and Risk of Late Graft Failure in Kidney Transplant Recipients: Results of the TransplantLines Biobank and Cohort Study

et al. 2021

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Recent studies have shown that depletion of vitamin C is frequent in outpatient kidney transplant recipients (KTR) and that vitamin C is inversely associated with risk of death. Whether plasma vitamin C is associated with death-censored kidney graft failure remains unknown. We investigated KTR who participated in the TransplantLines Insulin Resistance and Inflammation Biobank and Cohort Study. The primary outcome was graft failure (restart of dialysis or re-transplantation). Overall and stratified (pinteraction < 0.1) multivariable-adjusted Cox regression analyses are presented here. Among 598 KTR (age 51 ± 12 years-old; 55% males), baseline median (IQR) plasma vitamin C was 44.0 (31.0–55.3) µmol/L. Through a median follow-up of 9.5 (IQR, 6.3‒10.2) years, 75 KTR developed graft failure (34, 26, and 15 events over increasing tertiles of vitamin C, log-rank p < 0.001). Plasma vitamin C was inversely associated with risk of graft failure (HR per 1–SD increment, 0.69; 95% CI 0.54–0.89; p = 0.004), particularly among KTR with triglycerides ≥1.9 mmol/L (HR 0.46; 95% CI 0.30–0.70; p < 0.001; pinteraction = 0.01) and among KTR with HDL cholesterol ≥0.91 mmol/L (HR 0.56; 95% CI 0.38–0.84; p = 0.01; pinteraction = 0.04). These findings remained materially unchanged in multivariable-adjusted analyses (donor, recipient, and transplant characteristics, including estimated glomerular filtration rate and proteinuria), were consistent in categorical analyses according to tertiles of plasma vitamin C, and robust after exclusion of outliers. Plasma vitamin C in outpatient KTR is inversely associated with risk of late graft failure. Whether plasma vitamin C‒targeted therapeutic strategies represent novel opportunities to ease important burden of graft failure necessitates further studies.

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Plasma oxalate levels rise in hemodialysis patients despite increased oxalate removal.

Cited by 45 publications

References 29 publications

Oxalate Balance in Peritoneal Dialysis Patients: A Potential Role of Dialysis-related Peritonitis

Oxalate Balance in Peritoneal Dialysis Patients: A Potential Role of Dialysis-related Peritonitis

Extracorporeal treatment for ethylene glycol poisoning: systematic review and recommendations from the EXTRIP workgroup

Plasma Vitamin C and Risk of Late Graft Failure in Kidney Transplant Recipients: Results of the TransplantLines Biobank and Cohort Study

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