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

Imamaki, Hirotaka  ,  Ishii, Akira  ,  Yokoi, Hideki  ,  Kasahara, Masato  ,  Kuwabara, Takashige  ,  Mori, Keita P  ,  Kato, Yukiko  ,  Kuwahara, Takashi  ,  Satoh, Masugi  ,  Nakatani, Kimihiko  ,  Saito, Yoshihiko  ,  Tomosugi, Naohisa  ,  Sugawara, Akira  ,  Nakao, Kazuwa  ,  Mukoyama, Masashi  ,  Yanagita, Motoko  ,  Mori, Kiyoshi

10 ( 7 ) 2015-07-10 , Public Library of Science
[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.

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