Kidney Week

Abstract: TH-PO481

Effect of Oral Antibiotic Exposure on Urine Lithogenic Profile in ADPKD

Session Information

• Cystic Kidney Diseases: Clinical Assessment and Therapeutic Directions
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic

Authors

• Wang, Wei, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Wei Wang, MD

• Ostrow, Anna, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Anna Ostrow, MPH

• Klawitter, Jelena, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Jelena Klawitter, PhD

• Nowak, Kristen L., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Kristen L. Nowak, PhD, MPH

• Coleman, Erin R., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Erin R. Coleman, MPH

• George, Diana, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Diana George

• Nazzal, Lama, New York University, New York, New York, United States

Lama Nazzal, MD, MS, MSc

• Li, Huilin, New York University, New York, New York, United States

Huilin Li, PhD

• Goldfarb, David S., New York University Grossman School of Medicine, New York, New York, United States

David S. Goldfarb, MD, FASN

• Gitomer, Berenice Y., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Berenice Y. Gitomer, PhD

• Chonchol, Michel, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Michel Chonchol, MD, FASN

Background

Oral antibiotic use alters the gut microbiome leading to an increase in urine oxalate and risk for nephrolithiasis. However, this novel risk factor has not been explored in ADPKD patients who are frequently treated with oral antibiotics for recurrent urinary tract (UTI) and kidney cyst infections. The high incidence of KSD in patients with ADPKD underscores the importance of understanding this potential risk factor for progression.

Methods

Diagnosis of ADPKD was based on imaging or genetic testing and participants were required to have an eGFR ≥ 45 ml/min/1.73m². Subjects were recruited nationally between 2021-2024 and were stratified based on recent antibiotic use within the previous 6 months or no antibiotic use within the previous 3-years (control group). All participants had no history of KSD within the previous 5-years. Diet was assessed by ASA24 dietary intake tool (NCI) on 3-separate occasions and subjects completed a 24-hour urine and stool collection. The urine stone risk profile was assessed by Litholink™ (Labcorp, Itasca, Illinois).

Results

To date 15 participants with a history of antibiotic use (mean age 41±8 years) and 13 participants with no antibiotic use (mean age 41±8 years) have completed the study. All participants are female most likely due to the higher prevalence of UTI in females. Mean eGFR was 80±10 ml/min/1.73m² in subjects with recent antibiotic use and 79±12 ml/min/1.73m² in control subjects. The mean age 24-hour urine calcium excretion was significantly higher in patients with antibiotic use compared to the control subjects (136.5±63.5 vs. 91.2±52.7 mg/day P= 0.05). The supersaturation of calcium phosphate was also higher in patients with recent exposure to antibiotics compared to controls (0.67±0.69 vs. 0.28±0.22, P=0.06), however it did not reach significance. Urinary oxalate and citrate excretion did not differ between groups.

Conclusion

Patients with recent exposure to antibiotics have higher daily urine calcium excretion levels despite no apparent dietary differences. Analysis of additional subjects and fecal samples will be necessary to fully evaluate the potential effects of antibiotics in this patient population.

Funding

• NIDDK Support