Uromodulin [umod] is a kidney-derived glycoprotein & putative tubular function index. Higher serum umod levels were recently associated with reduced risk for graft failure [GF] during longitudinal follow-up, in a  study of 91 kidney transplant recipients [KTRs; n=13 GF events; Biomarkers. 2017; 22:171-177].

Using a case-cohort design (total n=613) from the FAVORIT trial [NCT00064753] of chronic, stable KTRs, we examined the association between baseline serum umod (random subcohort mean ± standard deviation [SD]: 67.8 ± 39.7 ng/mL), and the development of GF (n=226 events), during a median 4.1 years of follow-up. 

Unadjusted, weighted Cox proportional hazards modeling revealed that each SD higher (+39.7 ng/mL) of umod was associated with a 41% lower risk for GF. This association was attenuated, but persisted at 21% lower risk for GF per SD higher of serum umod, after adjustment for age, sex, smoking, graft type & vintage, prevalent diabetes & cardiovascular disease, total/HDL cholesterol ratio, systolic blood pressure, serum phosphorus, estimated glomerular filtration rate [mean 45.5, SD 18.1, mL/min per 1.73m2], & natural log urinary albumin/creatinine [mean 209.3, SD 636.3, mcg/mL]: (HR=0.79; 95% CI=0.64-0.97).