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Plasma neutrophil gelatinase-associated lipocalin is associated with iron status in anemic patients with pre-dialysis chronic kidney disease

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Abstract

Background

Iron deficiency anemia is common in patients with chronic kidney disease (CKD). Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of acute kidney injury, is known to be associated with iron metabolism. We investigated whether plasma NGAL level is associated with iron status in pre-dialysis CKD patients with anemia.

Methods

This study included 419 patients who had anemia. The subjects were into categorized into a pre-dialysis group (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2, n = 288) and a non-CKD group (eGFR >60 ml/min/1.73 m2, n = 131). The associations between plasma NGAL and iron status (serum ferritin and transferrin saturation [TSAT]), eGFR, albumin, uric acid, total cholesterol, calcium, phosphate, and C-reactive protein (CRP) were assessed.

Results

In non-CKD group, plasma NGAL was not associated with any baseline variables including iron indices (TSAT and serum ferritin). In pre-dialysis group, univariate analysis showed plasma NGAL correlated with eGFR, CRP, TSAT, and serum ferritin. In multivariate analysis, plasma NGAL was independently associated with TSAT. However, serum ferritin lost its association with plasma NGAL. In ROC analysis for identifying iron deficiency, the plasma NGAL (best cut-off value ≤394 ng/ml) was superior to the serum ferritin (suggested cut-off value ≤500 ng/ml) in both sensitivity and specificity.

Conclusions

Plasma NGAL is associated with iron status in anemic patients with pre-dialysis CKD. Further studies are needed to demonstrate the role of plasma NGAL in assessing the iron deficiency and in guiding the iron therapy for pre-dialysis CKD patients.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 50612, South Korea

    Il Young Kim, Joo Hui Kim, Dong Won Lee, Soo Bong Lee, Harin Rhee, Sang Heon Song, Eun Young Seong & Ihm Soo Kwak

  2. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Il Young Kim, Joo Hui Kim, Dong Won Lee & Soo Bong Lee

  3. Medical Research Institute, Pusan National University Hospital, Busan, South Korea

    Harin Rhee, Sang Heon Song, Eun Young Seong & Ihm Soo Kwak

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  1. Il Young Kim
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Correspondence to Soo Bong Lee.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (Pusan National University Yangsan Hospital Review Board IRB No. 05-2016-064) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived by the IRB due to the retrospective nature of the analysis using information contained in medical charts and records which were anonymized.

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Kim, I.Y., Kim, J.H., Lee, D.W. et al. Plasma neutrophil gelatinase-associated lipocalin is associated with iron status in anemic patients with pre-dialysis chronic kidney disease. Clin Exp Nephrol 22, 28–34 (2018). https://doi.org/10.1007/s10157-017-1409-6

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  • DOI: https://doi.org/10.1007/s10157-017-1409-6

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