Journal article
Combined Use of Serum Uromodulin and eGFR to Estimate Mortality Risk
FRONTIERS IN MEDICINE, v 8, 723546
08 Sep 2021
PMID: 34568379
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Serum uromodulin (sUmod) shows a strong direct correlation with eGFR in patients with impaired kidney function and an inverse association with mortality. However, there are patients in whom only one of both markers is decreased. Therefore, we aimed to investigate the effect of marker discordance on mortality risk. sUmod and eGFR were available in 3,057 participants of the Ludwigshafen Risk and Cardiovascular Health study and 529 participants of the VIVIT study. Both studies are monocentric prospective studies of patients that had been referred for coronary angiography. Participants were categorized into four groups according to the median values of sUmod (LURIC: 146 ng/ml, VIVIT: 156) and eGFR (LURIC: 84 ml/min/1.73 m(2), VIVIT: 87). In 945 LURIC participants both markers were high (UHGH), in 935 both were low (ULGL), in 589 only eGFR (UHGL), and in 582 only sUmod (ULGH) was low. After balancing the groups for cardiovascular risk factors, hazard ratios (95%CI) for all-cause mortality as compared to UHGH were 2.03 (1.63-2.52), 1.43 (1.13-1.81), and 1.32 (1.03-1.69) for ULGL, UHGL, and ULGH, respectively. In VIVIT, HRs were 3.12 (1.38-7.08), 2.38 (1.01-5.61), and 2.06 (0.81-5.22). Adding uromodulin to risk prediction models that already included eGFR as a covariate slightly increased the Harrell's C and significantly improved the AUC in LURIC. In UHGL patients, hypertension, heart failure and upregulation of the renin-angiotensin-aldosterone-system seem to be the driving forces of disease development, whereas in ULGH patients metabolic disturbances might be key drivers of increased mortality. In conclusion, SUmod/eGFR subgroups mirror distinct metabolic and clinical patterns. Assessing sUmod additionally to creatinine or cystatin C has the potential to allow a more precise risk modeling and might improve risk stratification.
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Details
- Title
- Combined Use of Serum Uromodulin and eGFR to Estimate Mortality Risk
- Publication Details
- FRONTIERS IN MEDICINE, v 8, 723546
- Publisher
- FRONTIERS MEDIA SA; LAUSANNE
- Grant note
- LURIC was supported by the 7th Framework Program RiskyCAD (grant agreement number 305739) of the European Union and the H2020 Program TO_AITION (grant agreement number 848146) of the European Union. The work of WM and MK was supported as part of the Competence Cluster of Nutrition and Cardiovascular Health (nutriCARD) which was funded by the German Federal Ministry of Education and Research. The work of GD was supported by the European Union's Horizon 2020 research and innovation programme under the ERA-Net Cofund action No 727565 (OCTOPUS project) and the German Ministry of Education and Research (grant number 01EA1801A). The funding sources were not involved in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:001026907800001
- Scopus ID
- 2-s2.0-85115620940
- Other Identifier
- 991021860752604721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Urology & Nephrology