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Title: Low Serum Neutrophil Gelatinase-associated Lipocalin Level as a Marker of Malnutrition in Maintenance Hemodialysis Patients.
Authors: Imamaki, Hirotaka
Ishii, Akira  kyouindb  KAKEN_id
Yokoi, Hideki  kyouindb  KAKEN_id
Kasahara, Masato
Kuwabara, Takashige
Mori, Keita P
Kato, Yukiko
Kuwahara, Takashi
Satoh, Masugi
Nakatani, Kimihiko
Saito, Yoshihiko
Tomosugi, Naohisa
Sugawara, Akira
Nakao, Kazuwa
Mukoyama, Masashi
Yanagita, Motoko  kyouindb  KAKEN_id
Mori, Kiyoshi
Author's alias: 森, 潔
Issue Date: 10-Jul-2015
Publisher: Public Library of Science
Journal title: PloS one
Volume: 10
Issue: 7
Thesis number: e0132539
Abstract: [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 χ2 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 β=0.40, P<0.001), peripheral blood neutrophil count (β=0.38, P<0.001) and anion gap (which likely reflects dietary protein intake, β=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.
Rights: © 2015 Imamaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI(Published Version): 10.1371/journal.pone.0132539
PubMed ID: 26161663
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