title: Plasma neutrophil gelatinase-associated lipocalin and kidney function decline and kidney disease-related clinical events in older women.
abstract: BACKGROUND
  It is still unclear whether serum neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of renal tubular injury, is a prognostic marker for the progression of chronic kidney disease (CKD) in the general population.
  
  
  METHODS
  A prospective-cohort study of 1,245 women aged ≥70 from the general population. Associations between plasma NGAL and change in 5-year estimated glomerular filtration rate (eGFR), rapid renal decline and 10-year risk of acute or chronic renal disease-related hospitalisations and/or mortality were examined.
  
  
  RESULTS
  Compared to women with above-median plasma NGAL of 76.5 ng/l, women with below-median plasma NGAL had a 9.3% reduction in eGFR over a 5-year period. Among women with above-median plasma NGAL, there was over a 1.7-fold increased risk of rapid renal decline (eGFR decline of >3 ml/min/year) (adjusted odds ratio 1.76, 95% CI 1.003, 3.102, p = 0.049). Compared to women with baseline eGFR of <60 ml/min/1.73 m(2), women with above-median plasma NGAL experienced over a 2.5-fold increased risk of renal disease events at 10 years (hazard ratio 2.55, 95% CI 1.13, 5.78, p = 0.025) after adjustment of age, hypertension and diabetes. Addition of plasma NGAL in participants with eGFR of <60 ml/min/1.73 m(2) significantly improved the accuracy in predicting the 10-year risk of renal disease events (adjusted area-under-curve receiver operator characteristics without and with NGAL 0.64 and 0.71, respectively; p = 0.027) and reclassified 13% of women who experienced renal disease events into the higher risk categories (p = 0.03).
  
  
  CONCLUSIONS
  Plasma NGAL is of modest clinical utility in predicting the renal function decline and risk of renal disease-related clinical events, particularly those with mild to moderate CKD.
authors.affiliation: University of Western Australia School of Medicine and Pharmacology, Perth, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Lewis
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Rachel
authors.initials: R
authors.lastname: Teo
authors.forename: Ee M
authors.initials: EM
authors.lastname: Lim
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Byrnes
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prince
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood*; D000209:Acute-Phase Proteins; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000401:mortality / Q000503:physiopathology
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins