Renal Functions and Prognosis Stratification in Chronic Heart Failure Patients and the Importance of Neutrophil Gelatinase-Associated Lipocalin

Abstract

Background/Aims: The rate of incidence and prevalence of acute kidney injury is increasing due to an increased number of patients with heart failure. Therefore it is very pertinent to early detect the level of renal injuries and to make necessary heart failure predictions. Thus the aim of this study is to determine renal functions and prognosis stratification in chronic heart failure patients and importance of Neutrophil Gelatinase-Associated Lipocalin (NGAL), an early diagnostic marker of acute kidney injury, as well as stratification of cardiovascular risk in heart failure patients. Methods: Data including age, gender, comorbidities and medical history of outpatients and hospitalized patients from Farmacology and NeuroHumoraL activation (FAR NHL) multicenter prospective registry comprising three Cardiological Centers in the Czech Republic were collected between 1st October 2014 and 30th November 2015. One-year follow-up data were collected in November 2016 in such a way that all patients had at least one-year data from the time of recruitment, but up to two years to the time of follow-up. One-year data were used for the whole set of patients while data up to 24 months were used with Kaplan-Meier‘s survival curves to analyse the patients‘ survival data. Blood samples were collected from the patients and basic parameters were evaluated in order to analyse Neutrophil gelatinase-associated lipocalin (NGAL) and plasma levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP) using Lipocalin-2/NGAL Human ELISA kit (Bio Vendor, Czechia) and the Cobas E411 NT-proBNP Immunoassay kit (Roche Diagnostics, Indianapolis, IN, USA) respectively. Statistical analysis was further carried out to explain the level of significance of the evaluated parameters using Spearman Correlation, Mann Whitney or Kruskal-Wallis test and log-rank test. Results: Out of 547 patients from Farmacology and NeuroHumoraL activation (FAR NHL) multicenter prospective registry with available data on hospitalizations, mortality, biomarkers and one-year follow-up that were recorded, there were 439 males (80.3%) with a median age of 66 years. At least one-month stable patients with left ventricle ejection fraction (LV EF) under 50% were recorded. The etiology of heart failure was ischemic heart disease in 54%, dilated cardiomyopathy in 40% and others in 6%. 69% patients were in New York Heart Association functional class II. There were 76 events (13.9%; all-cause mortality, acute heart failure hospitalization, left ventricle assist device implantation and orthotopic heart transplant) in the first 365 days of follow-up. The area under the receiver operating characteristic curve was higher for NT-proBNP (0.77) than the creatinine (0.57), NGAL (0.55) or creatinine clearance (0.54). In multivariable analyses, NT-proBNP (P= 0.001) and NGAL (P = 0.004) were significant predictors of events. Subjects with NT-proBNP and NGAL above the cut off value (NT-proBNP 1,121 pg/ml, NGAL 80 ng/ml) survived without any event in 55.7%, subjects with NT-proBNP and NGAL unde...

Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections

“…NGAL is increased in chronic renal injury. 27,28,29 If NGAL is elevated, there is more tubular production, as several authors have demonstrated, or because there is less tubular reabsorption, as has just been shown by Sancho-Martínez et al 29,30 Two urinary markers of kidney damage -NGAL and NAG -were lower in GA than GB both at the beginning and at the end of the study. These data are new: until now, it has not been described that the elderly with RUTI had these higher urine markers.…”

“…NGAL is increased in chronic renal injury. 27,28,29 If NGAL is elevated, there is more tubular production, as several authors have demonstrated, or because there is less tubular reabsorption, as has just been shown by Sancho-Martínez et al 29,30…”

“…Moderate dependence (41-60). Severe dependency(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Total dependence (0-20).…”

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

“…We hypothesized that elevated tubule damage markers at discharge -which represent residual tubular cell stress caused by pathogenic mechanisms (e.g., neurohumoral activation) or therapeutical efforts, are independent factors related to worse outcomes following an ADHF episode. Elevated urine NGAL has previously been linked to poorer outcomes in a variety of clinical settings, including CHF (GISSI-HF study) [31,32] and chronic kidney disease (CKD; CRIC study) [33]. Increased urine NGAL also appears to be a mortality risk factor in the elderly [34,35].…”

Assessment of glomerular and tubulointerstitial apparatus state depending on the level of the natriuretic peptide in hypertension patients

“…цев, но может быть предиктором сердечно-сосудистых событий у пациентов с хронической болезнью почек [5]. Исследования последних лет также показали, что уровень NGAL, связанный с NT-proBNP, был предиктором сердечно-сосудистых событий и смертности у пациентов с ХСН [14]. При этом исследователи показали, что уровень NGAL был выше у гипертоников.…”