Patients with chronic kidney disease (CKD) who have serum uromodulin levels higher than 55.6 ng/mL have lower risks for kidney failure, major adverse cardiovascular events (MACE), and early death, Dominik Steubl, MD, of Technical University of Munich in Germany, and colleagues reported in the Clinical Journal of the American Society of Nephrology.

In the German CKD study, the investigators stratified 5143 white patients with stage 3 or higher CKD or macroalbuminuria by baseline serum uromodulin levels, a potential marker of tubule function: 55.6 ng/mL or less (quartile 1), 55.6 to 83.4 ng/mL (quartile 2), 83.4 to 125.3 ng/mL (quartile 3), and more than 125.3 ng/mL (quartile 4). In multivariate analyses using quartile 1 as the referent, quartiles 2, 3, and 4 were significantly associated with 27%, 35%, and 76% lower risks for kidney failure, respectively, 15%, 22%, and 37% lower risks for MACE, and 20%, 30%, and 43% lower risks for all-cause mortality.

Patients with higher uromodulin levels tended to have fewer cardiovascular risk factors, higher estimated glomerular filtration rates, and lower albuminuria. The models adjusted for these factors, however.

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“The findings of our study may have clinical implications,” according to Dr Steubl’s team. “Given the fact that serum uromodulin is exclusively secreted in the tubular system and is independently associated with adverse outcomes, assessing tubular function by measuring serum uromodulin may guide medical treatment that affects the tubular system such as exposure to potentially tubulotoxic agents. In addition, low serum uromodulin concentrations may help to identify patients deserving more intensive care and optimization of cardiovascular risk factors.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Steubl D, Schneider MP, Meiselbach H, et al. Association of serum uromodulin with death, cardiovascular events, and kidney failure in CKD [published online April 14, 2020]. Clin J Am Soc Nephrol. doi: 10.2215/CJN.11780919

Ponte B, Devuyst O. Circulating uromodulin and risk of cardiovascular events and kidney failure [published online April 14, 2020]. Clin J Am Soc Nephrol. doi: 10.2215/CJN.03580320