Abstract: TH-PO109
Plasma Neutrophil Gelatinase Associated Lipocalin (NGAL) and the Prediction of Sustained AKI and Worsening Renal Function in Hospitalized Kidney Transplant Recipients
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Swolinsky, Jutta Sybille, Charité-Universitätsmedizin, Berlin, Germany
- Hinz, Ricarda Merle, Charité-Universitätsmedizin, Berlin, Germany
- Markus, Carolin Elfriede, Charité-Universitätsmedizin, Berlin, Germany
- Singer, Eugenia, Charité-Universitätsmedizin, Berlin, Germany
- Budde, Klemens, Charité-Universitätsmedizin, Berlin, Germany
- Eckardt, Kai-Uwe, Charité-Universitätsmedizin, Berlin, Germany
- Westhoff, Timm H., Ruhr Universität Bochum, Bochum, Germany
- Schmidt-Ott, Kai M., Charité-Universitätsmedizin, Berlin, Germany
Background
Neutrophil gelatinase-associated lipocalin (NGAL) and Calprotectin (CPT) have been validated as biomarkers of acute kidney injury (AKI) in multiple clinical settings. The utility of these biomarkers in post-transplant care of kidney transplant recipients (KTR) remains largely unclear. We hypothesized that NGAL and CPT levels, measured at the time of any unscheduled hospital admission after kidney transplantation, would be associated with episodes of sustained AKI (sAKI) and worsening renal function (WRF).
Methods
As part of a monocentric cohort study of 709 KTR, plasma and urinary NGAL and CPT levels were measured in 164 KTR at the time of hospital admission for any non-elective cause. sAKI was defined as an increase in creatinine by ≥0.3 mg/dl or by ≥1.5-fold compared to outpatient baseline that did not normalize within 72 hours (h). WRF was defined as an increase in creatinine by ≥0.5 mg/dl within 72 h after admission. ROC analyses, univariable and multivariable logistic regression analyses and net reclassification improvement (NRI) were assessed for the biomarkers in predicting sAKI and WRF.
Results
33 KTR developed sAKI, 12 developed WRF. Plasma NGAL (pNGAL) had the highest diagnostic accuracy compared to urinary NGAL, urinary and plasma CPT. Median pNGAL levels at admission were significantly higher in patients with sAKI (332 [IQR 247.5-633] ng/ml versus no sAKI 275 [IQR 193-363] ng/ml, p<0.05) and WRF (395 [IQR 305-639] ng/ml versus no WRF 278.5 [IQR 193.5-378.8] ng/ml, p<0.05). ROC analyses for pNGAL showed an AUC ROC of 0.66 for sAKI and of 0.75 for WRF. A pNGAL level >410 ng/ml had positive likelihood ratios of 2.3 (95% CI 1.38-3.81) for sAKI and of 2.0 (95% CI 1.15-4.1) for WRF. In multivariable logistic regression, pNGAL was an independent predictor of sAKI when combined with other predictors (serum creatinine, coronary artery disease, congestive heart failure, p<0.05). Adding pNGAL to conventional predictors of sAKI resulted in an NRI of 20.5% (p<0.01).
Conclusion
Elevated pNGAL at the time of hospital admission may be useful in identifying KTR at risk of sustained or progressive acute kidney injury. Although test characteristics speak against its use as a single biomarker, it may contribute to prognostication.
Funding
- Private Foundation Support