Abstract: FR-PO390

Urinary Uromodulin Independently Predicts ESRD and Rapid Kidney Function Decline in CKD Patients

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Author

  • Steubl, Dominik, Klinikum rechts der Isar , Munich, Germany

Group or Team Name

  • Munich Uromodulin Study Group
Background

Urinary uromodulin (uUMOD), exclusively secreted by the ascending limb of the loop of Henle and therefore a marker of tubular function has been shown to be a strong predictor of long term CKD progression and cardiovascular mortality. Data on risk factors predicting rapid progression to end-stage-renal-disease (ESRD) or rapid kidney function decline in chronic kidney disease (CKD) are rare but urgently needed to plan treatment. This article describes the predictive value of uUMOD for rapid progression of CKD.

Methods

We assessed uUMOD, demographic/treatment parameters, estimated glomerular filtration rate (eGFR) and proteinuria in 230 CKD patients stage I-V. ESRD or 25%-decline of eGFR was registered at the end of a follow-up of one year as the outcome variables. Association between logarithmic (log) uUMOD and (log) eGFR/proteinuria was calculated using linear regression analysis adjusted for demographic parameters. We performed multivariable Cox regression analysis to evaluate uUMOD as a predictor. Therefore, patients were categorized into quartiles. The predictive value was further assessed using receiver-operating-curve (ROC) analysis.

Results

Follow-up was 57.3±18.7 weeks. 47 (20.4%) patients reached the endpoint. (log) uUMOD concentrations were significantly associated with (log) eGFR and (log) proteinuria (r=0.554 and r=-0.429, p<0.001 resp.). In multivariable Cox-regression analysis, the two quartiles with the lowest uUMOD concentrations were at increased risk for ESRD/rapid eGFR loss with a hazard ratio (HR) of 3.589 (lowest quartile, uUMOD ≤ 2.6 µg/ml, 95%-confidence interval (CI) 1.002-12.992, p=0.049) and 5.409 (second lowest quartile, uUMOD 2.7-4.75 µg/ml, 95%-CI 1.444-20.269, p=0.011) in comparison to the highest quartile (≥ 11.45 µg/ml), respectively. In ROC-analysis, uUMOD predicted the endpoint with good sensitivity (74.6%) and specificity (76.6%) at an optimal-cut-off at 3.5 µg/ml and area-under-the-curve of 0.786 (95%-CI 0.712-0.860, p<0.001).

Conclusion

uUMOD was independently associated ESRD/rapid loss of eGFR. It might serve as a robust predictor of rapid kidney function decline and help to better schedule arrangements for future treatment.