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PLoS One. 2015 Jul 10;10(7):e0132539. doi: 10.1371/journal.pone.0132539. eCollection 2015.

Low Serum Neutrophil Gelatinase-associated Lipocalin Level as a Marker of Malnutrition in Maintenance Hemodialysis Patients.

Author information

1
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
2
Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
3
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
4
Department of Nephrology, Saiseikai Ibaraki Hospital, Osaka, Japan.
5
Misugikai Satou Hospital, Osaka, Japan.
6
First Department of Internal Medicine, Nara Medical University, Nara, Japan.
7
Division of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Kanazawa, Japan.
8
Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan.
9
TK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
10
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan; TMK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
11
TMK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Abstract

BACKGROUND:

Neutrophil gelatinase-associated lipocalin (NGAL or LCN2) is an iron-transporting factor which possesses various activities such as amelioration of kidney injury and host defense against pathogens. Its circulating concentrations are elevated in acute and chronic kidney diseases and show a positive correlation with poor renal outcome and mortality, but its clinical significance in maintenance hemodialysis (HD) patients remains elusive.

METHODS:

Serum NGAL levels were determined by enzyme-linked immunosorbent assay in out-patient, Japanese HD subjects. Their correlation to laboratory findings and morbidity (as development of severe infection or serum albumin reduction) was investigated using linear regression analysis and χ2 test.

RESULTS:

Pre-dialysis serum NGAL levels in HD patients were elevated by 13-fold compared to healthy subjects (n=8, P<0.001). In a cross-sectional study of 139 cases, serum NGAL concentrations were determined independently by % creatinine generation rate (an indicator of muscle mass, standardized coefficient β=0.40, P<0.001), peripheral blood neutrophil count (β=0.38, P<0.001) and anion gap (which likely reflects dietary protein intake, β=0.16, P<0.05). Iron administration to anemic HD patients caused marked elevation of peripheral blood hemoglobin, serum ferritin and iron-regulatory hormone hepcidin-25 levels, but NGAL levels were not affected. In a prospective study of 87 cases, increase in serum albumin levels a year later was positively associated to baseline NGAL levels by univariate analysis (r=0.36, P<0.01). Furthermore, within a year, patients with the lowest NGAL tertile showed significantly increased risk for marked decline in serum albumin levels (≥0.4 g/dl; odds ratio 5.5, 95% confidence interval 1.5-20.3, P<0.05) and tendency of increased occurrence of severe infection requiring admission (odds ratio 3.1, not significant) compared to the middle and highest tertiles.

CONCLUSION:

Low serum NGAL levels appear to be associated with current malnutrition and also its progressive worsening in maintenance HD patients.

PMID:
26161663
PMCID:
PMC4498679
DOI:
10.1371/journal.pone.0132539
[Indexed for MEDLINE]
Free PMC Article

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