The plasma level and biomarker value of neutrophil gelatinase-associated lipocalin in critically ill patients with acute kidney injury are not affected by continuous venovenous hemofiltration and anticoagulation applied

Abstract

IntroductionNeutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury (AKI), and levels reflect severity of disease in critically ill patients. However, continuous venovenous hemofiltration (CVVH) may affect plasma levels by clearance or release of NGAL by activated neutrophils in the filter, dependent on the anticoagulation regimen applied. We therefore studied handling of NGAL by CVVH in patients with AKI.MethodsImmediately before initiation of CVVH, prefilter blood was drawn. After 10, 60, 180, and 720 minutes of CVVH, samples were collected from pre- and postfilter (in- and outlet) blood and ultrafiltrate. CVVH with the following anticoagulation regimens was studied: no anticoagulation in case of a high bleeding tendency (n = 13), unfractionated heparin (n = 8), or trisodium citrate (n = 21). NGAL levels were determined with enzyme-linked immunosorbent assay (ELISA).ResultsConcentrations of NGAL at inlet and outlet were similar, and concentrations did not change over time in any of the anticoagulation groups; thus no net removal or production of NGAL occurred. Concentrations of NGAL at inlet correlated with disease severity at initiation of CVVH and at the end of a CVVH run. Concentrations of NGAL in the ultrafiltrate were lower with citrate-based CVVH (P = 0.03) and decreased over time, irrespective of anticoagulation administered (P < 0.001). The sieving coefficient and clearance of NGAL were low and decreased over time (P < 0.001).ConclusionsThe plasma level and biomarker value of NGAL in critically ill patients with AKI are not affected by CVVH, because clearance by the filter was low. Furthermore, no evidence exists for intrafilter release of NGAL by neutrophils, irrespective of the anticoagulation method applied.

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

“…The most important difference from previous studies was in the evaluation of the effect of serum NGAL on predicting the optimal time of CRRT discontinuation in our study. Previous study results and our results suggest that serum NGAL is hardly cleared during CRRT and that CRRT does not substantially influence serum NGAL concentration [13][14][15].…”

“…Compared with serum creatinine and CysC, NGAL has a higher molecular weight and is rarely removed by CRRT [13][14][15]. Therefore, serum NGAL might reflect the recovery of kidney function in patients undergoing CRRT.…”

Роль Нейтрофильных Лейкоцитов В патогенезе Сахарного Диабета 1-Го Типа У человека (Аналитический Обзор С включением Собственных Данных)

“…Совсем недавно были описаны еще два пептида (NGAL и ADAM9), секретируемые нейтрофилами, ко-торые обладают регуляторным действием на функцию капилляров [29]. Показано, что NGAL (Neutrophil Gelatinase-Association Lipocalin) оказывает индуцирующее влияние на дистальные тубулярные сегменты нефрона почек и может даже служить биологическим маркером острого почечного повреждения [30,39].…”

The Provision of Thromboprophylaxis and the Prediction of Renal Recovery in Critically Ill Patients with Acute Kidney Injury

“…While some studies have determined that clearance by the filter in CRRT is low, and have found no evidence of intra-filter release of NGAL by neutrophils [37,38], other studies have demonstrated that NGAL can be adsorbed and filtrated with polysulfone membranes [39]. De Geus et al theorized that larger serum proteins occlude membrane pores preventing the passage of NGAL.…”