Skip to main content Skip to main navigation menu Skip to site footer

Effectivity and safety profile of oxalate decarboxylase in hyperoxaluria patient: A meta-analysis and systematic review


Link of Video Abstract:


Introduction: The high incidence of urinary stones leads to many related medical issues and substantial financial burdens. In addition to treatment interventions, executing preventive measures is crucial in reducing the likelihood of kidney stone recurrence. Oxalate decarboxylase is now being developed as a preventive measure for treating hyperoxaluria, a risk factor for stone formation. This study aims to evaluate the efficacy and safety of oxalate decarboxylase in treating hyperoxaluria.

Methods: A comprehensive review of the existing literature was performed by conducting a systematic search across various databases, including Cochrane Library, Google Scholar, PubMed, and Embase. The mean difference (MD) of 24-hour urinary oxalate excretion from baseline to treatment was assessed in each study. Cochrane Collaboration’s Review Manager 5.4.1 software was used for statistical analysis, and RoB 2 tools were used for bias risk assessment.

Result: Five studies that satisfied the specified criteria were included in the analysis, 3  of which were analyzed for meta-analysis data, while the other for systematic review. Meta-analysis showed that oxalate decarboxylase had a statistically significant efficacy compared to placebo in reducing oxaluria with MD of 9,72 mg/day (95% CI 7,43 to 12,10). Regarding safety, there is not much difference in the number of complications between oxalate decarboxylase and placebo, with only one study reporting a serious adverse event (SAE) of sacral radiculopathy in the intervention group.

Conclusion: Oxalate decarboxylase is a potential and promising alternative treatment for reducing urinary oxalate levels in hyperoxaluria patients. Therefore, it can be regarded as a viable choice in pharmacological treatment for preventing the occurrence of oxalate stones in patients in the future.


  1. Abufaraj M, Xu T, Cao C, Waldhoer T, Seitz C, D’andrea D, et al. Prevalence and Trends in Kidney Stone Among Adults in the USA: Analyses of National Health and Nutrition Examination Survey 2007–2018 Data. Eur Urol Focus. 2021;7(6). doi:
  2. Bhasin B. Primary and secondary hyperoxaluria: Understanding the enigma. World J Nephrol. 2015;4(2). doi:
  3. Wang X, Zhang X, Wang L, Zhang R, Zhang Y, Cao L. Purslane-induced oxalate nephropathy: case report and literature review. BMC Nephrol. 2023;24(1). doi:
  4. Shee K, Stoller ML. Perspectives in primary hyperoxaluria — historical, current and future clinical interventions. Vol. 19, Nature Reviews Urology. 2022. doi:
  5. Conter C, Oppici E, Dindo M, Rossi L, Magnani M, Cellini B. Biochemical properties and oxalate-degrading activity of oxalate decarboxylase from bacillus subtilis at neutral pH. IUBMB Life. 2019;71(7). doi:
  6. Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K. EAU Guidelines on Urolithiasis. EAU Guidel Edn Present EAU Annu Congr Milan 2023. 2023;(March).
  7. Li K, Wang XF, Li DY, Chen YC, Zhao LJ, Liu XG, et al. The good, the bad, and the ugly of calcium supplementation: A review of calcium intake on human health. Vol. 13, Clinical Interventions in Aging. 2018. doi:
  8. Bargagli M, Ferraro PM, Vittori M, Lombardi G, Gambaro G, Somani B. Calcium and vitamin d supplementation and their association with kidney stone disease: A narrative review. Vol. 13, Nutrients. 2021. doi:10.3390/nu13124363
  9. Pfau A, Grujic D, Keddis MT, Kausz AT, Lieske JC, Knauf F. Pilot study of reloxaliase in patients with severe enteric hyperoxaluria and hyperoxalemia. Vol. 36, Nephrology Dialysis Transplantation. 2021. doi:
  10. Peck AB, Canales BK, Nguyen CQ. Oxalate-degrading microorganisms or oxalate-degrading enzymes: which is the future therapy for enzymatic dissolution of calcium-oxalate uroliths in recurrent stone disease? Vol. 44, Urolithiasis. 2016. doi:
  11. Lingeman JE, Pareek G, Easter L, Pease R, Grujic D, Brettman L, et al. ALLN-177, oral enzyme therapy for hyperoxaluria. Int Urol Nephrol. 2019;51(4). doi:
  12. Cowley H, Yan Q, Koetzner L, Dolan L, Nordwald E, Cowley AB. In vitro and in vivo safety evaluation of NephureTM. Regul Toxicol Pharmacol. 2017;86. doi:
  13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Vol. 372, The BMJ. 2021. doi:
  14. Deeks JJ, Higgins JP, Altman DG. Chapter 10: Analysing data and undertaking meta‐analyses. Cochrane Handb Syst Rev Interv. 2019;2(February).
  15. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. Cochrane Handbook for Systematic Reviews of Interventions. 2019. doi:
  16. Yagiz G, Akaras E, Kubis HP, Owen JA. The Effects of Resistance Training on Architecture and Volume of the Upper Extremity Muscles: A Systematic Review of Randomised Controlled Trials and Meta-Analyses. Vol. 12, Applied Sciences (Switzerland). 2022. doi:
  17. Langman CB, Grujic D, Pease RM, Easter L, Nezzer J, Margolin A, et al. A Double-Blind, Placebo Controlled, Randomized Phase 1 Cross-Over Study with ALLN-177, an Orally Administered Oxalate Degrading Enzyme. Am J Nephrol. 2016;44(2). doi:
  18. Quintero E, Bird VY, Liu H, Stevens G, Ryan AS, Buzzerd S, et al. A Prospective, Double-Blind, Randomized, Placebo-Controlled, Crossover Study Using an Orally Administered Oxalate Decarboxylase (OxDC). Kidney360. 2020;1(11). doi:
  19. Lieske JC, Lingeman JE, Ferraro PM, Wyatt CM, Tosone C, Kausz AT, et al. Randomized Placebo-Controlled Trial of Reloxaliase in Enteric Hyperoxaluria. NEJM Evid. 2022;1(7). doi:
  20. Cochat P, Groothoff J. Primary hyperoxaluria type 1: Practical and ethical issues. Vol. 28, Pediatric Nephrology. 2013. doi:
  21. Karaolanis G, Lionaki S, Moris D, Palla VV, Vernadakis S. Secondary hyperoxaluria: A risk factor for kidney stone formation and renal failure in native kidneys and renal grafts. Vol. 28, Transplantation Reviews. 2014. doi:
  22. Nazzal L, Puri S, Goldfarb DS. Enteric hyperoxaluria: An important cause of end-stage kidney disease. Vol. 31, Nephrology Dialysis Transplantation. 2016. doi:
  23. Ekser B, Mangus RS, Kubal CA, Fridell JA, Powelson JA, Nagaraju S, et al. Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria. Am J Nephrol. 2016;44(2). doi:
  24. Xu H, Zisman AL, Coe FL, Worcester EM. Kidney stones: An update on current pharmacological management and future directions. Vol. 14, Expert Opinion on Pharmacotherapy. 2013. doi:10.1517/14656566.2013.775250
  25. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2). doi:
  26. Noori N, Honarkar E, Goldfarb DS, Kalantar-Zadeh K, Taheri M, Shakhssalim N, et al. Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: A randomized controlled trial comparing DASH (dietary approaches to stop hypertension)-style and low-oxalate diets. Am J Kidney Dis. 2014;63(3). doi:
  27. Kraç M, Küpeli B, Irkilata L, Gülbahar Ö, Aksakal N, Karaoǧlan Ü, et al. Effects of dietary interventions on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones. Kaohsiung J Med Sci. 2013;29(2). doi:
  28. Holmes RP, Kennedy M. Estimation of the oxalate content of foods and daily oxalate intake. In: Kidney International. 2000. doi:
  29. Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Vol. 23, Current Pain and Headache Reports. 2019. doi:
  30. Furman MB, Johnson SC. Induced lumbosacral radicular symptom referral patterns: a descriptive study. Spine J. 2019;19(1). doi:
  31. Chen T, Qian B, Zou J, Luo P, Zou J, Li W, et al. Oxalate as a potent promoter of kidney stone formation. Vol. 10, Frontiers in Medicine. 2023. doi:
  32. Siener R, Ebert D, Nicolay C, Hesse A. Dietary risk factors for hyperoxaluria in calcium oxalate stone formers. Kidney Int. 2003;63(3). doi:
  33. Spradling K, Vernez SL, Khoyliar C, Morgan JB, Okhunov Z, Preminger GM, et al. Prevalence of Hyperoxaluria in Urinary Stone Formers: Chronological and Geographical Trends and a Literature Review. Vol. 30, Journal of Endourology. 2016. doi:

How to Cite

Rodjani, A., Putra, C. N. ., Raharja, P. A. R. ., Widia, F. ., Situmorang, G. R. ., Rahardjo, H. E. ., & Wahyudi, I. . (2024). Effectivity and safety profile of oxalate decarboxylase in hyperoxaluria patient: A meta-analysis and systematic review. Bali Medical Journal, 13(1), 782–789.




Search Panel

Arry Rodjani
Google Scholar
BMJ Journal

Christian Nurtanto Putra
Google Scholar
BMJ Journal

Putu Angga Risky Raharja
Google Scholar
BMJ Journal

Fina Widia
Google Scholar
BMJ Journal

Gerhard Reinaldi Situmorang
Google Scholar
BMJ Journal

Harrina Erlianti Rahardjo
Google Scholar
BMJ Journal

Irfan Wahyudi
Google Scholar
BMJ Journal