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Association of plasma neutrophil gelatinase-associated lipocalin with parameters of CKD–MBD in maintenance hemodialysis patients

Journal of Bone and Mineral Metabolism volume 39, pages 1058–1065 (2021)Cite this article

Abstract

Introduction

Neutrophil gelatinase-associated lipocalin (NGAL) is not only a biomarker of kidney injury but also a bone-derived factor involved in metabolism. We aimed to explore relationships between plasma NGAL and chronic kidney disease-mineral bone disorder (CKD-MBD) parameters in maintenance hemodialysis (MHD) patients.

Materials and methods

First, a cross sectional observational study, including 105 MHD patients, was conducted to explore relationships between plasma NGAL levels and CKD–MBD parameters. Second, impact of parathyroidectomy and auto-transplantation (PTX + AT) on plasma NGAL was investigated in 12 MHD patients with severe secondary hyperparathyroidism (SHPT).

Results

According to Spearman correlation analysis, plasma NGAL levels were positively correlated with female (r = 0.243, P = 0.012), vintage (r = 0.290, P = 0.003), Klotho (r = 0.234, P = 0.016), calcium(Ca) (r = 0.332, P = 0.001), alkaline phosphatase (ALP) (r = 0.401, P < 0.001) and intact parathyroid hormone (iPTH) (r = 0.256, P = 0.008); while inversely correlated with albumin(Alb) (r = − 0.201, P = 0.039). After adjusting for age, sex, vintage, Alb and all parameters of CKD–MBD(Ca, P, lg(ALP), lg(iPTH), Klotho and fibroblast growth factor 23(FGF23)), lg(NGAL) were positively correlated with Ca (r = 0.481, P < 0.001), P (r = 0.336, P = 0.037), lg(ALP) (r = 0.646, P < 0.001) in Partial correlation analysis; further multiple linear regression analysis showed same positive associations between lg(NGAL) and Ca (β = 0.330, P = 0.002), P (β = 0.218, P = 0.037), lg(ALP) (β = 0.671, P < 0.001). During the 4–7 days after PTX + AT, plasma NGAL decreased from 715.84 (578.73, 988.14) to 688.42 (660.00, 760.26) ng/mL (P = 0.071), Klotho increased from 496.45 (341.73, 848.30) to 1138.25 (593.87, 2009.27) pg/mL (P = 0.099).

Conclusion

Plasma NGAL levels were positively associated with ALP in MHD patients; and downtrends were shown after PTX + AT in patients with severe SHPT. These findings suggest that NGAL is a participant in CKD–MBD under MHD condition.

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Acknowledgements

We would like to thank Dr Fang Tang, at center for data science in health and medicine, the First Affiliated Hospital of Shandong First Medical University, Jinan, China, for their valuable inputs in data analysis. The authors’ responsibilities were as follows- XJ and DX: designed research; XJ, KW, JC, YW, ZW, YL, LL and LW: conducted research; XJ, XK and YL: analyzed data; XJ, DX, KW, LX and YW: wrote the paper; DX: had primary responsibility for final content; and all authors: read and approved the final manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (81970615 to Dongmei Xu); the National Natural Science Foundation of China (82004088 to Kai Wei); the National Natural Science Foundation of China (82000728 to Xianglei Kong).

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Authors and Affiliations

  1. Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, 250014, China

    Xiao-yan Jia, Kai Wei, Juan Chen, Xiang-lei Kong, Yong Wei, Li Wang, Zun-song Wang, Yi-peng Liu, Li-ming Liang & Dong-mei Xu

  2. Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Jinan, China

    Xiao-yan Jia, Kai Wei, Juan Chen, Xiang-lei Kong, Yong Wei, Li Wang, Zun-song Wang, Yi-peng Liu, Li-ming Liang & Dong-mei Xu

  3. Shandong Provincial Insititute of Nephrology, Jinan, China

    Xiao-yan Jia, Kai Wei, Juan Chen, Xiang-lei Kong, Yong Wei, Li Wang, Zun-song Wang, Yi-peng Liu, Li-ming Liang & Dong-mei Xu

  4. Department of Plastic and Reconstructive Surgery, Shandong Provincial Qianfoshan Hospital, Jinan, China

    Lin-he Xi

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  1. Xiao-yan Jia
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Correspondence to Dong-mei Xu.

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Jia, Xy., Wei, K., Chen, J. et al. Association of plasma neutrophil gelatinase-associated lipocalin with parameters of CKD–MBD in maintenance hemodialysis patients. J Bone Miner Metab 39, 1058–1065 (2021). https://doi.org/10.1007/s00774-021-01248-9

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Keywords

  • Neutrophil gelatinase-associated lipocalin
  • Alkaline phosphatase
  • Chronic kidney disease-mineral bone disorder
  • Maintenance hemodialysis