ORLANDO – Low serum uromodulin proved to be an independent predictor of all-cause mortality in a prospective study of 529 patients with stable coronary artery disease followed for up to 8 years, according to Christoph Saely, MD, vice president of the Vorarlberg Institute for Vascular Investigation and Treatment in Feldkirch, Austria.
“Baseline serum uromodulin is a valuable biomarker to predict overall mortality in coronary patients independent from kidney disease and the presence of type 2 diabetes. The lower the serum uromodulin, the higher the mortality,” he noted in an interview at the annual meeting of the American College of Cardiology.
In addition to presenting new evidence at ACC 2018 of serum uromodulin’s merits as a predictor of increased mortality risk in patients with CAD, Dr. Saely and his coinvestigators also showed that low serum uromodulin is associated with chronic kidney disease, type 2 diabetes, and prediabetes. Moreover, those with normal glucose metabolism and kidney function but a low serum uromodulin at baseline were at increased risk of developing abnormal glucose metabolism and impaired renal function during 4 years of follow-up.
Of the 529 patients with stable CAD, 95 died during follow-up. Among those with a low baseline serum uromodulin, defined bimodally as a level below 123.3 ng/mL, the mortality rate was 27.6%, roughly twice the 13.7% figure in patients with a baseline uromodulin above that threshold.
In a multivariate analysis adjusted extensively for age, sex, smoking, LDL cholesterol, HDL cholesterol, C-reactive protein, diabetes, estimated glomerular filtration rate, and N-terminal pro b-type natriuretic peptide level, a high baseline serum uromodulin was independently associated with a 43% reduction in the risk of mortality, according to Dr. Saely, who is both a cardiologist and an endocrinologist.
The overall mortality rate was 41% in patients with diabetes and a low baseline uromodulin, 20% in those with low uromodulin but not diabetes, 18% in diabetic patients with high uromodulin, and less than 13% with high uromodulin and no diabetes.
Enzyme-linked immunosorbent assay tests for uromodulin are marketed in Europe but remain investigational for now in the United States.
Dr. Saely reported having no financial conflicts of interest; the study was conducted without commercial support.
SOURCE: Saely C. ACC 2018, Abstract 1212-418/418.