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Low Serum Neutrophil Gelatinase-associated Lipocalin Level as a Marker of
Malnutrition in Maintenance Hemodialysis Patients
#MMPMID26161663
Imamaki H
; Ishii A
; Yokoi H
; Kasahara M
; Kuwabara T
; Mori KP
; Kato Y
; Kuwahara T
; Satoh M
; Nakatani K
; Saito Y
; Tomosugi N
; Sugawara A
; Nakao K
; Mukoyama M
; Yanagita M
; Mori K
PLoS One
2015[]; 10
(7
): e0132539
PMID26161663
show ga
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 ?2 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 ?=0.40, P<0.001), peripheral
blood neutrophil count (?=0.38, P<0.001) and anion gap (which likely reflects
dietary protein intake, ?=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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