Clinical Edge

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Urinary Oxalate Excretion & Risk of CKD Progression

JAMA Intern Med; ePub 2019 Mar 4; Waikar, et al

In individuals with chronic kidney disease (CKD) stages 2 to 4, higher 24-hour urinary oxalate excretion may be a risk factor for CKD progression and end-stage renal disease (ESRD), a new study found. Researchers assessed 3,123 individuals with CKD stages 2 to 4 CKD to determine whether urinary oxalate excretion is a risk factor for more rapid progression of CKD toward kidney failure. The primary outcomes were a 50% decline in estimated glomerular filtration rate (eGFR) and ESRD. They found:

  • During 22,318 person-years of follow-up, 752 individuals reached ESRD, and 940 reached the composite end point of ESRD or 50% decline in eGFR (CKD progression).
  • Higher oxalate excretion was independently associated with greater risks of both CKD progression and ESRD.
  • Higher urinary excretion of oxalate was associated with a 37% greater adjusted risk of future end-stage kidney disease.


Waikar SS, Srivastava A, Palsson R, et al. Association of urinary oxalate excretion with the risk of chronic kidney disease progression. [Published online ahead of print March 4, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.7980.