NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A BIOMARKER OF IRON DEFICIENCY AMONG EGYPTIAN HAEMODIALYSIS PATIENTS

Main Article Content

ALAA SABRY
AHMED EL BAHEY
AHMED AL ESSAWY
HEBA MOSAAD

Abstract

Objectives: Evaluation of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in a small cohort of patients in order to assess any relationships it may have with the iron balance, and its utility as a biomarker of iron deficiency.

Methods: This cross sectional study of 80 regular haemodialysis (HD) patients (51 males and 29 females) selected from dialysis units of Eldakahlia hospitals. The study was done over a period of one year. All patients were on fixed dose of recombinant erythropoietin therapy for at least 6 weeks and none received intravenous iron administration or packed red cell transfusion during the 2 months preceding the start of the study. Patients were divided into two groups; Group (1): - Patients with transferrin saturation (TSAT) < 30% considerd as iron deficient group, Group (2):- Patients with TSAT > 30% considered as iron repleted group. NGAL was      measured in the serum using the (Enzyme Linked Immunosorbant Assay) ELISA commercially available kit (NOVA) bioneovan company, China according to the manufacture`s instruments and its level was expressed as ng/ml.

Results: NGAL levels were significantly higher in HD patients compared to control non HD group. HD patients with TSAT <30% had lower NGAL values than HD patients with TSAT >30%. In Receiver operating characteristics (ROC) analysis for identifying iron deficiency, the plasma NGAL (best cut-off value ≤ 51.893 ng/ml) was superior to the serum ferritin (suggested cut-off value ≤ 500 ng/ ml) in both sensitivity and specificity.

Conclusion: Plasma NGAL is associated with iron status in HD patients. Finally, NGAL might be proposed as a new tool in the assessment of iron deficiency useful in the management of iron therapy for HD patients but further studies are needed to demonstrate the role of plasma NGAL in assessing the iron deficiency and in guiding the iron therapy for HD patients.

Keywords:
Haemodialysis, Anemia, Iron deficiency, Iron status, and Neutrophil gelatinase associated lipocalin

Article Details

How to Cite
SABRY, A., BAHEY, A. E., ESSAWY, A. A., & MOSAAD, H. (2021). NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A BIOMARKER OF IRON DEFICIENCY AMONG EGYPTIAN HAEMODIALYSIS PATIENTS. Journal of Medicine and Health Research, 6(2), 1-11. Retrieved from https://www.ikprress.org/index.php/JOMAHR/article/view/6771
Section
Clinical Practice Articles

References

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS. Prevalence of chronic kidney disease in the United States. Jama. 2007;298(17):2038-2047.

Silverberg DS. The role of erythropoiesis stimulating agents and intravenous (IV) iron in the cardio renal anemia syndrome. Heart Failure Reviews. 2011;16(6):609-614.

Obrador GT, Ruthazer R, Arora P, Kausz AT, Pereira BJ. Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. Journal of the American Society of Nephrology. 1999;10(8):1793-1800.

National KF. KDOQI clinical practice guidelines and clinical practice recommenda-tions for anemia in chronic kidney disease. American journal of kidney diseases: The Official Journal of the National Kidney Foundation. 2006;47(5 Suppl 3):S11.

Kidney Disease Improving Global Outcomes (KDIGO) Anemia Work Group: KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2:3.

Rambod M, Kovesdy CP, Kalantar-Zadeh K. Combined high Serum ferritin and low iron saturation in hemodialysis patients: The role of inflammation. Clinical Journal of the American Society of Nephrology. 2008;3(6):1691-1701.

Wish JB. Assessing iron status: Beyond serum ferritin and transferrin saturation. Clinical Journal of the American Society of Nephrology. 2006;1(Supplement 1):S4-S8.

Yang J, Goetz D, Li JY, Wang W, Mori K, Setlik D, Du T, Erdjument-Bromage H, Tempst P, Strong R, Barasch J. An iron delivery pathway mediated by a lipocalin. Molecular Cell. 2002;10(5):1045-1056.

Bolignano D, Donato V, Coppolino G, Campo S, Buemi A, Lacquaniti A, Buemi M. Neutrophil gelatinase–associated lipocalin (NGAL) as a marker of kidney damage. American Journal of Kidney Diseases. 2008; 52(3):595-605.

Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR, Nicocia G, Buemi M. Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2009;4(2): 337-344.

Ali A, Fathy GA, Fathy HA, Abd El-Ghaffar N. Epidemiology of iron deficiency Anaemia: Effect on physical growth in primary school children, the importance of hookworms. International Journal of Academic Research. 2011;3(1).

Rambod M, Kovesdy CP, Kalantar-Zadeh K. Combined high serum ferritin and low iron saturation in hemodialysis patients: the role of inflammation. Clinical Journal of the American Society of Nephrology. 2008;3(6):1691-1701.

Nickolas TL, Barasch J, Devarajan P. Biomarkers in acute and chronic kidney disease. Current Opinion in Nephrology and Hypertension. 2008;17(2):127-132.

Mori K, Lee HT, Rapoport D, Drexler IR, Foster K, Yang J, Schmidt-Ott KM, Chen X, Li JY, Weiss S, Mishra J. Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. The Journal of Clinical Investigation. 2005; 115(3):610-621.

Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: A systematic review and meta-analysis. American Journal of Kidney Diseases. 2009;54(6):1012-1024.

Malyszko J, Bachorzewska-Gajewska H, Poniatowski B, Malyszko JS, Dobrzycki S. Urinary and serum biomarkers after cardiac catheterization in diabetic patients with stable angina and without severe chronic kidney disease. Renal failure. 2009;31(10):910-919.

Damman K, Veldhuisen DJ, Navis G, Voors AA, Hillege HL. Urinary neutrophil gelatinase associated lipocalin (NGAL), a marker of tubular damage, is increased in patients with chronic heart failure. European Journal of Heart Failure. 2008;10(10):997-1000.

Xu S, Venge P. Lipocalins as biochemical markers of disease. Biochimica et Biophysica Acta (BBA)-Protein Structure and Molecular Enzymology. 2000;1482(1-2):298-307.

Wish JB. Past, present and future of chronic kidney disease anemia management in the United States. Advances in Chronic Kidney Disease. 2009;16(2):101-108.

Locatelli F. European best practice guidelines working group: Revised European best practice guidelines for the management of anemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19(2).

Jiang W, Constante M, Santos MM. Anemia up regulates lipocalin 2 in the liver and serum. Blood Cells, Molecules and Diseases. 2008; 41(2):169-174.

Yang J, Goetz D, Li JY, Wang W, Mori K, Setlik D, Du T, Erdjument-Bromage H, Tempst P, Strong R, Barasch J. An iron Delivery Pathway Mediated by a Lipocalin. Molecular Cell. 2002;10(5):1045-1056.

Jönsson P, Ståhl ML, Ohlsson K. Extracorporeal circulation causes release of neutrophil gelatinase-associated lipocalin (NGAL). Mediators of Inflammation. 1999; 8(3):169-171.