Neutrophil gelatinase-associated lipocalin (NGAL) fails as an early predictor of contrast induced nephropathy in chronic kidney disease (ANTI-CI-AKI study)

Werner Ribitsch, Gernot Schilcher, Franz Quehenberger, Stefan Pilz, Rupert H Portugaller, Martini Truschnig-Wilders, Robert Zweiker, Marianne Brodmann, Philipp Stiegler, Alexander R Rosenkranz, John W Pickering, Joerg H Horina, Werner Ribitsch, Gernot Schilcher, Franz Quehenberger, Stefan Pilz, Rupert H Portugaller, Martini Truschnig-Wilders, Robert Zweiker, Marianne Brodmann, Philipp Stiegler, Alexander R Rosenkranz, John W Pickering, Joerg H Horina

Abstract

The aim of the study was to evaluate the diagnostic accuracy of urinary neutrophil gelatinase- associated lipocalin (uNGAL) in patients with chronic kidney disease (CKD) as an early biomarker for contrast induced acute kidney injury (CI-AKI) and to investigate whether patients with an uNGAL increase might benefit from an additional intravenous volume expansion with regard to CI-AKI-incidence. We performed a prospective randomized controlled trial in 617 CKD-patients undergoing intra-arterial angiography. Urinary NGAL was measured the day before and 4-6hrs after angiography. In the event of a significant rise of uNGAL patients were randomized either into Group A, who received intravenous saline post procedure or Group B, who did not receive post-procedural i.v. fluids. Ten patients (1.62%) exhibited a significant rise of uNGAL after angiography and were randomized of whom one developed a CI-AKI. In the entire cohort the incidence of CI-AKI was 9.4% (58 patients) resulting in a specificity of 98.4% (95% CI: 97.0-99.3%) and a sensitivity of 1.72% (95% CI: 0.044-9.2%) of uNGAL for the diagnosis of CI-AKI. In this study uNGAL failed to predict CI-AKI and was an inadequate triage tool to guide an early intervention strategy to prevent CI-AKI.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01292317.

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1. Enrollment, randomization and renal outcome…
Figure 1. Enrollment, randomization and renal outcome during the ANTI-CI-AKI-study.
Figure 2. NGAL and CI-AKI diagnosis on…
Figure 2. NGAL and CI-AKI diagnosis on a logarithmic scale.
Black: Patients without CI-AKI; Red: Patients with CI-AKI; Shaded area: Patients with significant increase of NGAL. Diagonal dotted line: Patients without significant change of uNGAL. Diagonal dashed line: Patients with doubling of uNGAL after angiography. Area below dotted line: Patients with decrease of uNGAL.
Figure 3. The receiver operating characteristic (ROC)…
Figure 3. The receiver operating characteristic (ROC) curve for uNGAL to predict CI-AKI.
The Area under the Curve was 0.51 (95% CI: 0.43–0.59).

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