Evaluation of the uromodulin profile and classical markers in risk stratification for progression of chronic kidney disease stages 1–3

This study presents a comparative analysis of the analytical informativeness of indices within the uromodulin profile–fractional excretion of uromodulin (FeUmod), fractional secretion of uromodulin (FsUmod), and serum uromodulin (sUmod) – as well as classical markers of kidney function: serum creatinine (sCrea), estimated glomerular filtration rate (eGFR) by the CKD-EPI formula, albuminuria (uAlb), and the albumin-to-creatinine ratio (uAlb/uCrea) in patients with chronic kidney disease (CKD) stages 1–3. Aim of the study. To assess the diagnostic performance of uromodulin profile indices (FeUmod, FsUmod, sUmod) compared to classical markers of kidney function (sCrea, eGFR, uAlb, uAlb/uCrea) in patients with CKD stages 1–3. Materials and methods. The study included 91 patients with CKD stages 1–3. Biomarker levels were analyzed at three time points: T0 (baseline), T1 (after 3 months), and T2 (after 6 months). Correlation analysis was performed to assess associations between biomarkers. The discriminatory ability to detect reduced eGFR < 60 mL/min/1.73 m² was evaluated using ROC analysis. Cluster analysis was employed to identify phenotypes of renal functional status. Results. At the final time point (T2), FeUmod demonstrated the highest discriminatory performance, surpassing sCrea, FsUmod, sUmod, and uAlb/uCrea. In correlation analysis, FeUmod also showed the strongest association with eGFR. Cluster analysis identified three distinct phenotypes of patients characterized by different patterns of tubular and glomerular dysfunction. Conclusions. Indices of the uromodulin profile, particularly FeUmod, exceed classical markers of kidney function in their ability to stratify the risk of decreased renal filtration capacity in patients with CKD stages 1–3. Incorporating FeUmod into laboratory monitoring tools in nephrology and general clinical practice is advisable.