Il Young Kim1,2, Joo Hui Kim1,2, Dong Won Lee1,2, Soo Bong Lee3,4, Harin Rhee1,5, Sang Heon Song1,5, Eun Young Seong1,5, Ihm Soo Kwak1,5. 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. 2. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. 3. Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 50612, South Korea. sbleemd@pusan.ac.kr. 4. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. sbleemd@pusan.ac.kr. 5. Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
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.
BACKGROUND:Irondeficiency 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 CKDpatients 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 anemicpatients 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 CKDpatients.
Entities:
Keywords:
Anemia; Chronic kidney disease; Iron deficiency; Neutrophil gelatinase-associated lipocalin
Authors: David H Goetz; Margaret A Holmes; Niels Borregaard; Martin E Bluhm; Kenneth N Raymond; Roland K Strong Journal: Mol Cell Date: 2002-11 Impact factor: 17.970
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