Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study.

Abstract

BACKGROUND:

Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown.

OBJECTIVES:

This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents.

METHODS:

This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events.

RESULTS:

We enrolled 927 subjects (mean age, 68.5 years; 62% men). The primary outcome occurred in 72 subjects (7.8%). Peak NGAL was more predictive than the first NGAL, but neither added significant diagnostic utility over the first creatinine (areas under the curve: 0.656, 0.647, and 0.652, respectively). There were 235 adverse events in 144 subjects. The first NGAL was a better predictor than peak NGAL, but similar to the first creatinine (areas under the curve: 0.691, 0.653, and 0.686, respectively). In a post hoc analysis of subjects with an estimated glomerular filtration rate <60 ml/min/1.73 m(2), a first NGAL <150 ng/ml indicated a low likelihood of adverse events.

CONCLUSIONS:

Plasma NGAL was not superior to creatinine for the prediction of WRF or adverse in-hospital outcomes. The use of plasma NGAL to diagnose acute kidney injury in AHF cannot be recommended at this time. (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin [N-GAL] Evaluation of Symptomatic Heart Failure Study [AKINESIS]; NCT01291836).

• Authors: Alan S Maisel, Nicholas Wettersten, Dirk J van Veldhuisen, Christian Mueller, Gerasimos Filippatos, Richard Nowak, Christopher Hogan, Michael C Kontos, Chad M Cannon, Gerhard A Müller, Robert Birkhahn, Paul Clopton, Pam Taub, Gary M Vilke, Kenneth McDonald, Niall Mahon, Julio Nuñez, Carlo Briguori, Claudio Passino, Patrick T Murray
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 68 Issue 13 Pg. 1420-1431 (09 27 2016) ISSN: 1558-3597 [Electronic] United States
• PMID: 27659464 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Diuretics
• Lipocalin-2
• Creatinine

Topics

• Acute Disease
• Acute Kidney Injury (blood, diagnosis, etiology)
• Aged
• Aged, 80 and over
• Cohort Studies
• Creatinine (blood)
• Diuretics (therapeutic use)
• Female
• Heart Failure (blood, complications, drug therapy)
• Hospitalization
• Humans
• Lipocalin-2 (blood)
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Prospective Studies