Successful Management of Enteric Hyperoxaluria (EH) Using a Nurse (RN)-Driven Protocol

Background: Enteric hyperoxaluria (EH) is a common cause of nephrolithiasis in patients with fat malabsorption syndromes. Up to 60% of biopsy-proven oxalate nephropathy cases have been attributed to EH. Current management strategies include a rigorous low fat & oxalate diet and calcium supplementation with meals to act as an oxalate binder. Effective management requires regular monitoring and feedback to patients with careful titration of calcium supplementation to control hyperoxaluria yet minimize possible hypercalciuria Methods: EH patients at Mayo Clinic Rochester (n=140) were enrolled in an RN-driven protocol (Image 1). Here we report data on 85 not requiring renal replacement therapy Results: As shown in Image 2, the protocol lowered urine oxalate (72 to 58 mg/24hr), was not associated with hypercalciuria or hypercalcemia, and reduced Ca-Ox supersaturation. Stone burden remained stable or reduced in >53% of patients and eGFR remained stable. Average CaCO3 dose 2.6g TID with meals & 644 mg BID with snack Conclusion: An RN-run protocol focused on calcium supplementation and low-oxalate diet education can effectively manage hyperoxaluria in EH patients. Patients benefitted from the standardized approach, frequent touchpoints, and feedback based upon the lab results