title: Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients.
abstract: BACKGROUND
  Tubulointerstitial damage is a final common pathway of most renal diseases. Whether urinary neutrophil gelatinase-associated lipocalin (uNGAL), a biomarker for renal tubular damage, is of prognostic value for clinical outcomes in chronic kidney disease (CKD) patients has not been well investigated.
  
  
  METHODS
  The uNGAL and proteinuria levels were measured among a cohort of 473 advanced CKD patients of various etiologies recruited during 2002-2009.
  
  
  RESULTS
  The estimated glomerular filtration rate (eGFR) was 32.3±22.0 mL/min/1.73 m2 with a urine protein-to-creatinine ratio (UPCR) 680 (255-1248) mg/g and 132 (27.9%) participants had diabetes. The baseline uNGAL level was significantly associated with male gender, eGFR, UPCR, and hemoglobin. The hazard ratio (HR) of the highest uNGAL tertile for end-stage renal disease (ESRD) was 3.44 (95% CI 1.47-8.06, p=0.004). With the adjustment of urine creatinine and urine protein, HR of the highest urine NGAL-to-creatinine ratio (UNCR) tertile and the highest urine NGAL-to-protein ratio (UNPR) tertile was 3.06 (95% CI 1.19-7.90, p=0.02) and 2.10 (95% CI 1.13-3.89, p=0.02), respectively. UNPR increased the prediction of survival model for ESRD. HR of the highest UNCR tertile and UNPR tertile for cardiovascular (CV) events was 2.21 (95% CI 0.81-5.98, p=0.08) and 2.79 (95% CI 1.25-6.26, p=0.01), respectively. None of these were associated with all-cause mortality.
  
  
  CONCLUSIONS
  Elevated uNGAL in CKD patients is associated with risks for ESRD and probably CV events. UNPR could improve the prediction for ESRD.
authors.forename: Hugo You-Hsien
authors.identifier: http://orcid.org/0000-0001-6888-4138
authors.initials: HY
authors.lastname: Lin
authors.forename: Daw-Yang
authors.initials: DY
authors.lastname: Hwang
authors.forename: Su Chu
authors.initials: SC
authors.lastname: Lee
authors.forename: Hung-Tien
authors.initials: HT
authors.lastname: Kuo
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Kuo
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000150:complications; D011518:Proto-Oncogene Proteins / Q000652:urine*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology / Q000652:urine*; D018570:Risk Assessment
chemical_list: D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine