Assessment of Plasma Oxalate Concentration in Patients With CKD

Kidney Int Rep. 2020 Sep 2;5(11):2013-2020. doi: 10.1016/j.ekir.2020.08.029. eCollection 2020 Nov.


Introduction: Alterations in oxalate homeostasis are associated with kidney stone disease and progression of chronic kidney disease (CKD). However, accurate measurement of plasma oxalate (POx) concentrations in large patient cohorts is challenging as prompt acidification of samples has been deemed necessary. In the present study, we investigated the effects of variations in sample handling on POx results and examined an alternative strategy to the established preanalytical procedures.

Methods: The effect of storage time at room temperature (RT) and maintenance of samples at -80°C was tested. POx was measured in 1826 patients enrolled in the German Chronic Kidney Disease (GCKD) study, an ongoing multicenter, prospective, observational cohort study.

Results: We demonstrate that POx concentrations increased rapidly when samples were maintained at RT. This was most relevant for POx <10 μM, as concentrations more than doubled within a few hours. Immediate freezing on dry ice and storage at -80°C provided stable results and allowed postponement of acidification for >1 year. In the patients of the lowest estimated glomerular filtration rate (eGFR) quartile, median POx was 2.7 μM (interquartile range [IQR] <2.0-4.2) with a median eGFR of 25.1 ml/min per 1.73 m2 (IQR 20.3-28.1).

Conclusion: We conclude that immediate freezing and maintenance of plasma samples at -80°C facilitates the sample collection process and allows accurate POx assessment in large cohorts. The present study may serve as a reference for sample handling to assess POx in clinical trials and to determine its role in CKD progression.

Keywords: POx concentration; POx measurement; chronic kidney disease; clinical trials; preanalytical conditions.