{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:50:08Z","timestamp":1792083008904,"version":"4.4.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"\n Background:<\/jats:title>\n Residual kidney function (RKF) monitoring is essential to safe incremental hemodialysis (HD) prescription. Yet the cumbersome nature of interdialytic urine collections represents a major barrier to routine implementation. We investigated serum uromodulin, as a marker of functional renal mass, in identifying HD patients with clinically significant RKF when used alone, or in combination with serum \u03b22-microglobulin, a traditional marker of glomerular filtration.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We conducted a prospective observational study of 151 HD patients at two centers in Geneva, Switzerland. Serum uromodulin and \u03b22-microglobulin were measured on pre-dialysis samples, and residual urea clearance (KRU) was determined by interdialytic timed urine collection. The discriminative performance of each biomarker for identifying patients with KRU \u22652 mL\/min\/35L was assessed by receiver operating characteristic (ROC) analysis, and the two markers were then combined using logistic regression. We applied a two-threshold grey-zone strategy, defining a priori rule-out and rule-in cutoffs to achieve \u226590% sensitivity and specificity, respectively.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Of the 151 patients, 92 (61%) had KRU <2 mL\/min\/35L and 59 (39%) had KRU \u22652 mL\/min\/35L. Serum uromodulin discriminated KRU \u22652 mL\/min\/35L with an area under the curve (AUC) of 0.891 (95% CI 0.839\u20130.944), statistically equivalent to \u03b22-microglobulin (AUC 0.877; P=0.66). Each marker contributed independent information: the combined model achieved an AUC of 0.923 (95% CI 0.883\u20130.964), superior to either alone (vs uromodulin P=0.03; vs \u03b22-microglobulin P=0.01). Using the grey-zone strategy, uromodulin alone classified 76% of patients without urine collection (negative predictive value (NPV) 97%, positive predictive value (PPV) 84%), while the combined model classified 85%. Restricting analysis to non-anuric patients modestly decreased discrimination (AUC 0.833) with preserved PPV (84%), while avoiding the need for urine collection in 80% of this sub-group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Serum uromodulin provides RKF information orthogonal to and non-redundant with conventional filtration markers. Their combination reliably identifies the KRU \u22652 mL\/min\/35L threshold relevant to incremental hemodialysis, sparing most patients from urine collection.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001247","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:00:27Z","timestamp":1792080027000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Estimating Residual Kidney Function in Hemodialysis Patients Using Serum Uromodulin"],"prefix":"10.2215","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3841-3049","authenticated-orcid":false,"given":"David A.","family":"Jaques","sequence":"first","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Jotterand Drepper","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0478-9965","authenticated-orcid":false,"given":"Nicola","family":"Marangon","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3744-4767","authenticated-orcid":false,"given":"Olivier","family":"Devuyst","sequence":"additional","affiliation":[{"name":"Institute of Physiology, University of Zurich, Zurich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4243-366X","authenticated-orcid":false,"given":"Sophie","family":"De Seigneux","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Saudan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belen","family":"Ponte","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,15]]},"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:00:27Z","timestamp":1792080027000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2215\/cjn.0000001247","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-07-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}