Kidney Week

Abstract: SA-PO529

Plasma Uromodulin and Cardiovascular Outcomes in Adults with Hypertension and CKD

Session Information

• Hypertension and CVD: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Ikeme, Jesse C., University of California San Francisco, San Francisco, California, United States

Jesse C. Ikeme,

• Scherzer, Rebecca, University of California San Francisco, San Francisco, California, United States

Rebecca Scherzer,

• Garimella, Pranav S., University of California San Diego, La Jolla, California, United States

Pranav S. Garimella,

• Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States

Michelle M. Estrella,

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix,

• Shlipak, Michael, University of California San Francisco, San Francisco, California, United States

Michael Shlipak,

Background

Uromodulin (UMOD) is an emerging kidney tubule biomarker that may improve identification of persons at elevated cardiovascular (CV) risk beyond conventional markers. We evaluated the association of plasma UMOD with CV outcomes in CKD.

Methods

This was a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), in which an intensive systolic blood pressure (SBP) target reduced risk of CV events and mortality. We measured plasma UMOD at baseline in participants with eGFR <60 ml/min/1.73 m² (N = 2302) and evaluated its association with a composite primary outcome of nonfatal myocardial infarction (MI), acute coronary syndrome without MI, acute decompensated heart failure (HF), stroke or CV death. Hazard ratios (HR) were estimated using Cox proportional hazards models adjusted for demographic and clinical variables, including eGFR and albuminuria.

Results

Median follow-up was 3.9 years, mean eGFR was 46 (IQR: 36–55) mL/min/1.73 m² and median plasma UMOD was 17.2 (IQR: 12.3–23.2) ng/ml. In the lowest UMOD quartile, 105 out of 575 (18.3%) experienced the primary outcome compared to 57 out of 575 (9.9%) in the highest. After multivariable adjustment, higher UMOD was not significantly associated with the primary outcome in the overall cohort. Of the component outcomes, each SD higher UMOD was associated with 30% lower risk of stroke (HR 95%CI: 0.51–0.95, p <.01) only. The association of UMOD with the primary and HF outcomes differed by eGFR (p for each interaction <.05) (Figure). Each SD higher UMOD was associated with 24% lower risk of the primary outcome (HR 95%CI: 0.63–0.91) and 33% lower risk of HF (HR 95%CI: 0.51–0.89) in those with eGFR <45 ml/min/1.73 m² (p <.01 for both), but not among those with eGFR ≥45 ml/min/1.73 m².

Conclusion

Higher plasma UMOD in hypertensive persons with CKD is associated with lower risk of stroke and, among those with lower eGFR, lower risk of CV and HF events.

Funding

• NIDDK Support