Kidney Week

Abstract: SA-PO0574

Antibiotic Exposure and Risk of Urinary Stone Disease (USD) in Patients with ADPKD

Session Information

• Cystic Kidney Diseases: Clinical Research
  November 08, 2025 | 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: Monogenic Kidney Diseases

Authors

• Arai, Ema R, University of Colorado System, Denver, Colorado, United States

Ema R Arai

• You, Zhiying, University of Colorado System, Denver, Colorado, United States

Zhiying You, MD, PhD

• Ostrow, Anna, University of Colorado System, Denver, Colorado, United States

Anna Ostrow, MPH

• Nowak, Kristen L., University of Colorado System, Denver, Colorado, United States

Kristen L. Nowak, PhD, MPH

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

Lama Nazzal, MD, MS

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

Huilin Li, PhD

• Goldfarb, David S., New York University, New York, New York, United States

David S. Goldfarb, MD, FASN

• Gitomer, Berenice Y., University of Colorado System, Denver, Colorado, United States

Berenice Y. Gitomer, PhD

• Chonchol, Michel, University of Colorado System, Denver, Colorado, United States

Michel Chonchol, MD, FASN

Background

USD is a common comorbidity in ADPKD patients and a risk factor for faster progression. Oral antibiotic exposure has been associated with increased risk for USD due to microbiome changes; whether this is the case in ADPKD patients is unknown.

Methods

A matched case-control study was conducted using data from the HALT-PKD randomized clinical trials. Among 1,043 adults aged 18-64 years with ADPKD who were enrolled, 521 patients were eligible for analysis. 109 cases had a history of USD during the study period. Each case was matched with up to four controls (n = 412) based on age (±3 years), sex, and race at the time of USD diagnosis (index date). Data on any antibiotic use prior to the index date, along with demographic variables and baseline estimated glomerular filtration rate (eGFR), were obtained from trial records. Conditional logistic regression models were used to evaluate the association between antibiotic use and USD. A sensitivity analysis, which only included patients who used antibiotics specifically limited to five predefined antibiotic classes (cephalosporins, nitrofurantoin, penicillins, quinolones, and sulfonamides), was also performed.

Results

Among included participants, the mean age was 41 ± 9 years, 49% were female, and the average baseline eGFR was 72 ± 26 mL/min/1.73 m². Antibiotic use was significantly associated with USD (odds ratio [OR] 3.52, 95% confidence interval [CI] 2.16, 5.76, p < 0.0001), even after adjusting for baseline eGFR (adjusted OR 3.55, CI 2.14, 5.90, p < 0.0001). After including only patients (n=321; 40 ± 10 years; 74 ± 28 mL/min/1.73 m² ) who received antibiotics limited to five predefined antibiotic classes, the relationship between antibiotic use and USD remained unchanged, with an unadjusted OR of 2.48 (95% CI 1.27, 4.84, p = 0.008) and an adjusted OR of 2.66 (95% CI 1.33, 5.29, p = 0.006).

Conclusion

In ADPKD, oral antibiotic use is associated with a higher odds of kidney stone disease. These findings suggest that characterization of the intestinal microbiome in order to direct therapies improving its ability to counteract stone formation would have value.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20256ey1q2mw