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Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients.
Clin Chem Lab Med. 2015 Jan; 53(1):73-83.CC

Abstract

BACKGROUND

Tubulointerstitial damage is a final common pathway of most renal diseases. Whether urinary neutrophil gelatinase-associated lipocalin (uNGAL), a biomarker for renal tubular damage, is of prognostic value for clinical outcomes in chronic kidney disease (CKD) patients has not been well investigated.

METHODS

The uNGAL and proteinuria levels were measured among a cohort of 473 advanced CKD patients of various etiologies recruited during 2002-2009.

RESULTS

The estimated glomerular filtration rate (eGFR) was 32.3±22.0 mL/min/1.73 m2 with a urine protein-to-creatinine ratio (UPCR) 680 (255-1248) mg/g and 132 (27.9%) participants had diabetes. The baseline uNGAL level was significantly associated with male gender, eGFR, UPCR, and hemoglobin. The hazard ratio (HR) of the highest uNGAL tertile for end-stage renal disease (ESRD) was 3.44 (95% CI 1.47-8.06, p=0.004). With the adjustment of urine creatinine and urine protein, HR of the highest urine NGAL-to-creatinine ratio (UNCR) tertile and the highest urine NGAL-to-protein ratio (UNPR) tertile was 3.06 (95% CI 1.19-7.90, p=0.02) and 2.10 (95% CI 1.13-3.89, p=0.02), respectively. UNPR increased the prediction of survival model for ESRD. HR of the highest UNCR tertile and UNPR tertile for cardiovascular (CV) events was 2.21 (95% CI 0.81-5.98, p=0.08) and 2.79 (95% CI 1.25-6.26, p=0.01), respectively. None of these were associated with all-cause mortality.

CONCLUSIONS

Elevated uNGAL in CKD patients is associated with risks for ESRD and probably CV events. UNPR could improve the prediction for ESRD.

Authors

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Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25153411

Citation

Lin, Hugo You-Hsien, et al. "Urinary Neutrophil Gelatinase-associated Lipocalin and Clinical Outcomes in Chronic Kidney Disease Patients." Clinical Chemistry and Laboratory Medicine, vol. 53, no. 1, 2015, pp. 73-83.
Lin HY, Hwang DY, Lee SC, et al. Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients. Clin Chem Lab Med. 2015;53(1):73-83.
Lin, H. Y., Hwang, D. Y., Lee, S. C., Kuo, H. T., Kuo, M. C., Chang, J. M., Tsai, J. C., Hung, C. C., Hwang, S. J., & Chen, H. C. (2015). Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients. Clinical Chemistry and Laboratory Medicine, 53(1), 73-83. https://doi.org/10.1515/cclm-2014-0647
Lin HY, et al. Urinary Neutrophil Gelatinase-associated Lipocalin and Clinical Outcomes in Chronic Kidney Disease Patients. Clin Chem Lab Med. 2015;53(1):73-83. PubMed PMID: 25153411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients. AU - Lin,Hugo You-Hsien, AU - Hwang,Daw-Yang, AU - Lee,Su Chu, AU - Kuo,Hung-Tien, AU - Kuo,Mei-Chuan, AU - Chang,Jer-Ming, AU - Tsai,Jer-Chia, AU - Hung,Chi-Chih, AU - Hwang,Shang-Jyh, AU - Chen,Hung-Chen, PY - 2014/05/09/received PY - 2014/06/25/accepted PY - 2014/8/26/entrez PY - 2014/8/26/pubmed PY - 2015/8/13/medline SP - 73 EP - 83 JF - Clinical chemistry and laboratory medicine JO - Clin Chem Lab Med VL - 53 IS - 1 N2 - BACKGROUND: Tubulointerstitial damage is a final common pathway of most renal diseases. Whether urinary neutrophil gelatinase-associated lipocalin (uNGAL), a biomarker for renal tubular damage, is of prognostic value for clinical outcomes in chronic kidney disease (CKD) patients has not been well investigated. METHODS: The uNGAL and proteinuria levels were measured among a cohort of 473 advanced CKD patients of various etiologies recruited during 2002-2009. RESULTS: The estimated glomerular filtration rate (eGFR) was 32.3±22.0 mL/min/1.73 m2 with a urine protein-to-creatinine ratio (UPCR) 680 (255-1248) mg/g and 132 (27.9%) participants had diabetes. The baseline uNGAL level was significantly associated with male gender, eGFR, UPCR, and hemoglobin. The hazard ratio (HR) of the highest uNGAL tertile for end-stage renal disease (ESRD) was 3.44 (95% CI 1.47-8.06, p=0.004). With the adjustment of urine creatinine and urine protein, HR of the highest urine NGAL-to-creatinine ratio (UNCR) tertile and the highest urine NGAL-to-protein ratio (UNPR) tertile was 3.06 (95% CI 1.19-7.90, p=0.02) and 2.10 (95% CI 1.13-3.89, p=0.02), respectively. UNPR increased the prediction of survival model for ESRD. HR of the highest UNCR tertile and UNPR tertile for cardiovascular (CV) events was 2.21 (95% CI 0.81-5.98, p=0.08) and 2.79 (95% CI 1.25-6.26, p=0.01), respectively. None of these were associated with all-cause mortality. CONCLUSIONS: Elevated uNGAL in CKD patients is associated with risks for ESRD and probably CV events. UNPR could improve the prediction for ESRD. SN - 1437-4331 UR - https://www.unboundmedicine.com/medline/citation/25153411/Urinary_neutrophil_gelatinase_associated_lipocalin_and_clinical_outcomes_in_chronic_kidney_disease_patients_ DB - PRIME DP - Unbound Medicine ER -