High oxalate concentrations correlate with increased risk for sudden cardiac death in dialysis patients

Pfau A, Ermer T, Coca SG, Tio MC, Genser B, Reichel M, Finkelstein FO, März W, Wanner C, Waikar SS, Eckardt KU, Aronson PS, Drechsler C, Knauf F (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Journal of the American Society of Nephrology American Society of Nephrology

Book Volume: 32

Pages Range: 2375-2385

Journal Issue: 9

DOI: 10.1681/ASN.2020121793

Abstract

Background The clinical significance of accumulating toxic terminal metabolites such as oxalate in patients with kidney failure is not well understood. Methods To evaluate serum oxalate concentrations and risk of all-cause mortality and cardiovascular events in a cohort of patients with kidney failure requiring chronic dialysis, we performed a post-hoc analysis of the randomized German Diabetes Dialysis (4D) Study; this study included 1255 European patients on hemodialysis with diabetes followed-up for a median of 4 years. The results obtained via Cox proportional hazards models were confirmed by competing risk regression and restricted cubic spline modeling in the 4D Study cohort and validated in a separate cohort of 104 US patients on dialysis after a median follow-up of 2.5 years. Results A total of 1108 patients had baseline oxalate measurements,with a median oxalate concentration of 42.4 μM.During follow-up, 548patients died, including139 (25.4%) fromsudden cardiac death.Atotal of 413 patients reached the primary composite cardiovascular end point (cardiac death, nonfatalmyocardial infarction, and fatal or nonfatal stroke). Patients in the highest oxalate quartile (≥59.7 μM) had a 40%increased risk for cardiovascular events (adjusted hazard ratio [aHR], 1.40; 95% confidence interval [95% CI], 1.08 to 1.81) and a 62% increased risk of sudden cardiac death (aHR, 1.62; 95% CI, 1.03 to 2.56), compared with those in the lowest quartile ( ≤ 29.6 mM). The associations remained when accounting for competing risks and with oxalate as a continuous variable. Conclusions Elevated serumoxalate is a novel risk factor for cardiovascular events and sudden cardiac death inpatients ondialysis. Further studies arewarranted to testwhether oxalate-lowering strategies improve cardiovascular mortality in patients on dialysis.

Authors with CRIS profile

Theresa Ermer Medizinische Fakultät Kai-Uwe Eckardt Department of Medicine 4 – Nephrology and Hypertension

Involved external institutions

Charité - Universitätsmedizin Berlin DE Germany (DE) Icahn School of Medicine at Mount Sinai US United States (USA) (US) BGStats Consulting AT Austria (AT) Ruprecht-Karls-Universität Heidelberg DE Germany (DE) Yale School of Medicine US United States (USA) (US) Universitätsklinikum Würzburg DE Germany (DE) Boston Medical Center (BMC) US United States (USA) (US) Brigham and Women's Hospital (BWH) US United States (USA) (US)

How to cite

APA:

Pfau, A., Ermer, T., Coca, S.G., Tio, M.C., Genser, B., Reichel, M.,... Knauf, F. (2021). High oxalate concentrations correlate with increased risk for sudden cardiac death in dialysis patients. Journal of the American Society of Nephrology, 32(9), 2375-2385. https://doi.org/10.1681/ASN.2020121793

MLA:

Pfau, Anja, et al. "High oxalate concentrations correlate with increased risk for sudden cardiac death in dialysis patients." Journal of the American Society of Nephrology 32.9 (2021): 2375-2385.

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