PHYSICIAN GUIDED, NURSE DRIVEN GUIDELINE TO MANAGE ENTERIC HYPEROXALURIA (EH) - BY ETIOLOGY

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PHYSICIAN GUIDED, NURSE DRIVEN GUIDELINE TO MANAGE ENTERIC HYPEROXALURIA (EH) - BY ETIOLOGY

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Co-author 1

HARSHIL FICHADIYA FICHADIYA.HARSHIL@MAYO.EDU MAYO CLINIC NEPHROLOGY ROCHESTER United States *

Co-author 2

BRIGID AMBERG AMBERG.BRIGID@MAYO.EDU MAYO CLINIC NEPHROLOGY ROCHESTER United States -

Co-author 3

HATEM AMER HATEM.AMER@MAYO.EDU MAYO CLINIC NEPHROLOGY ROCHESTER United States -

Co-author 4

JOHN LIESKE LIESKE.JOHN@MAYO.EDU MAYO CLINIC NEPHROLOGY ROCHESTER United States -

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Introduction

EH is characterized by increased urinary oxalate excretion (>0.5 mmol or 45 mg/24h) in patients with fat malabsorption. Multiple biliary, pancreatic and enteric etiologies have been identified, however malabsorptive bariatric surgery remains a leading cause. While some therapies are currently under investigation and some have been tried with limited success in the past, the current management approach involves a low oxalate, low fat diet along with meal time calcium supplementation. We devised a physician guided, nurse driven protocol for management of EH without causing hypercalciuria.

Methods

A quasi experimental trial was performed with 84 patients not requiring renal replacement therapy between 2015 and 2025, workflow attached in image. 24 h urine calcium oxalate supersaturation (Ca-ox SS), oxalate and urine were obtained using electronic data pull. Data was analyzed using Shapiro- Wilk test and Wilcoxon paired test. Values are reported as medians due to non-normal distribution. Here we report our data stratified by etiology of EH.

Results

As in image, across all groups the median urine Ca-ox SS and oxalate reduced considerably with the exception of mild increase in Ca-ox SS in the small bowel resection group (however this group demonstrates reduction in urine oxalate) . Overall with reduction in Ca-ox SS and urine oxalate without causing significant hypercalciuria, our guideline helped with reducing EH across all major etiologies. Overall the radiographic stone burden also reduced (50% had stable to reduced stone burden). Average dose of calcium carbonate was 3g TID with meals.

Conclusion

A physician guided, nurse driven approach utilizing frequent monitoring of oxalate and calcium to guide low oxalate diet and meal time calcium supplementation can help with reducing urine oxalate and Ca-OX SS across all major etiologies.

Kewords