A Novel Approach for Reducing Hyperoxaluria and Kidney Stone Risk.

The University of Texas System (UT)

Status and phase: Enrolling; Phase 4

Conditions: Hyperoxaluria

Treatments: Other: Placebo; Drug: Tenapanor

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06481150

1UL1TR003163 (U.S. NIH Grant/Contract)

STU-2023-1257

Details and patient eligibility

About

This pilot study is proposing a novel approach to directly target intestinal oxalate absorption with the drug Tenapanor, which was recently FDA-approved for treating hyperphosphatemia in patients with chronic kidney disease. Tenapanor works by blocking paracellular phosphate absorption by the intestine, but the underlying mechanisms have not been clearly defined. Since phosphate and oxalate ions are absorbed through the same paracellular pathway, and are of similar size and charge, Tenapanor is hypothesized to also reduce dietary oxalate absorption and consequently lower urinary oxalate excretion.

Full description

The proposed proof-of-concept studies will determine whether Tenapanor reduces urine oxalate in normal human subjects receiving a high-oxalate diet in a crossover placebo-controlled short-term metabolic study.

Study Design Screening - One 24-hour urine for analysis of stone-risk profile, one blood sample for comprehensive metabolic panel and cystatin C, one stool sample for fecal calprotectin, physical exam, social and medical history, vital signs, demographic information, personal information.This is a two-phase study, each phase is 5 days in duration.

Phase 1: The subjects will consume a pre-prepared oxalate-rich metabolic diet for 5 days while taking 30 mg Tenapanor or Placebo twice a day just prior to the morning and evening meals. On days 4 and 5 they will collect two 24-hour urines for measurement of urine oxalate and stone-risk profile.

Washout: The subjects will undergo a 9-day washout period. Phase 2: The subjects will consume a pre-prepared oxalate-rich metabolic diet for 5 days while taking 30 mg Tenapanor or Placebo twice a day just prior to the morning and evening meals. On days 4 and 5 they will collect two 24-hour urines for measurement of urine oxalate and stone-risk profile.

Enrollment: 10 estimated patients

Sex: All

Ages: 18 to 99 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Normal, healthy adult volunteers

Exclusion criteria

• Personal history of kidney stones
• Pregnant or nursing
• Recurrent urinary tract infections
• Lithogenic urine chemistry at baseline (oxalate > 45 mg/24 h, urine calcium > 300 mg/24 h)
• Chronic kidney disease (eGFR < 90 mL/min/1.73m2)
• Personal history of GI disease, GI obstruction, or GI surgery
• Chronic diarrhea
• Intestinal inflammation (Fecal calprotectin > 120 mcg/g)
• Drugs which are substrates of OATP2B1 (e.g. enalapril)
• Chronic use of sodium polystyrene sulfonate, angiotensin-converting enzyme inhibitors, diuretics, antacids, alkali treatment, or carbonic anhydrase inhibitors.

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Triple Blind

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10 participants in 2 patient groups, including a placebo group

Tenapanor

Experimental group

Description:

30 mg Tenapanor twice a day

Treatment:

Drug: Tenapanor

Placebo

Placebo Comparator group

Description:

30 mg Placebo twice a day

Treatment:

Other: Placebo