Dysbiotic Gut Microbiota Correlates with Altered Serum and Urinary Biomarkers in Recurrent Calcium Oxalate Stone Patients

Baolin Zhang,1 Ting Li,2 Ziyang Qiang,1 Lan Ma,3 Xiangfeng Kong,1 Shuang Chen1 1Department of Urology, Qinghai University Affiliated Hospital, Xining, Qinghai, 810000, People’s Republic of China; 2School of Pharmacy, Medical College of Qinghai University, Xining, Qinghai, 810000, People’s Republic of China; 3Clinical Teaching and Research Section, Qinghai Health Vocational and Technical College, Xining, Qinghai, 810000, People’s Republic of ChinaCorrespondence: Ziyang Qiang, Email [email protected]: To explore associations between gut microbiota composition, blood/urine biochemical markers, and recurrent calcium oxalate stones, identifying potential risk factors.Methods: A retrospective study compared 88 patients (≥ 2 stone episodes, 2023– 2025) with 90 age/gender-matched controls. Fecal 16S rRNA sequencing assessed microbial diversity, alongside blood lipid profiles, creatinine, uric acid, and 24-hour urine analysis. Multivariate logistic regression identified independent predictors.Results: Baseline demographics were comparable (P > 0.05). Patients exhibited higher Escherichia coli and Fusobacterium, lower Faecalibacterium and Lachnospira (P < 0.05). Elevated triglycerides, creatinine, reduced HDL-C, and lower urinary magnesium/citrate (P < 0.05) were observed. Spearman analysis linked E. coli abundance to higher creatinine (r = 0.598) and lower HDL-C (r = − 0.607), while Faecalibacterium inversely correlated with creatinine (r = − 0.624; all P < 0.05). Logistic regression identified E. coli abundance, serum creatinine, and urinary magnesium as independent recurrence risk factors (P < 0.05).Conclusion: Gut microbiota dysbiosis correlates with metabolic and urinary abnormalities in recurrent stone formers. Monitoring E. coli levels and biochemical parameters may aid recurrence prediction.Keywords: calcium oxalate nephrolithiasis, gut microbiota, biochemical indicators, hyperoxaluria, influencing factors