Neutrophil Gelatinase-Associated Lipocalin for Acute Kidney Injury During Acute Heart Failure Hospitalizations: The AKINESIS Study

• Published in: Journal of the American College of Cardiology Vol. 68; no. 13; pp. 1420 - 1431
• Main Authors: Maisel, Alan S, Wettersten, Nicholas, van Veldhuisen, Dirk J, Mueller, Christian, Filippatos, Gerasimos, Nowak, Richard, Hogan, Christopher, Kontos, Michael C, Cannon, Chad M, Müller, Gerhard A, Birkhahn, Robert, Clopton, Paul, Taub, Pam, Vilke, Gary M, McDonald, Kenneth, Mahon, Niall, Nuñez, Julio, Briguori, Carlo, Passino, Claudio, Murray, Patrick T
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 27.09.2016
• Subjects: Acute coronary syndromes; Acute Disease; Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; Biomarkers; Cardiology; Cardiovascular disease; Chronic obstructive pulmonary disease; Cohort Studies; Coronary vessels; Creatinine - blood; Diuretics; Diuretics - therapeutic use; Dyspnea; Enrollments; Family medical history; Female; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - complications; Heart Failure - drug therapy; Hemodialysis; Hospitalization; Humans; Kidney diseases; Laboratories; Lipocalin-2 - blood; Male; Middle Aged; Neutrophils; Predictive Value of Tests; Prognosis; Prospective Studies; Review boards; Studies; worsening renal function; diuretics; biomarkers; cardiorenal syndrome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.06.055

Worsening renal function (WRF) often occurs during acute heart failure (AHF) and can portend adverse outcomes; therefore, early identification may help mitigate risk. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel renal biomarker that may predict WRF in certain disorders, but its value in AHF is unknown. This study sought to determine whether NGAL is superior to creatinine for prediction and/or prognosis of WRF in hospitalized patients with AHF treated with intravenous diuretic agents. This was a multicenter, prospective cohort study enrolling patients presenting with AHF requiring intravenous diuretic agents. The primary outcome was whether plasma NGAL could predict the development of WRF, defined as a sustained increase in plasma creatinine of 0.5 mg/dl or ≥50% above first value or initiation of acute renal-replacement therapy, within the first 5 days of hospitalization. The main secondary outcome was in-hospital adverse events. We enrolled 927 subjects (mean age, 68.5 years; 62% men). The primary outcome occurred in 72 subjects (7.8%). Peak NGAL was more predictive than the first NGAL, but neither added significant diagnostic utility over the first creatinine (areas under the curve: 0.656, 0.647, and 0.652, respectively). There were 235 adverse events in 144 subjects. The first NGAL was a better predictor than peak NGAL, but similar to the first creatinine (areas under the curve: 0.691, 0.653, and 0.686, respectively). In a post hoc analysis of subjects with an estimated glomerular filtration rate <60 ml/min/1.73 m(2), a first NGAL <150 ng/ml indicated a low likelihood of adverse events. Plasma NGAL was not superior to creatinine for the prediction of WRF or adverse in-hospital outcomes. The use of plasma NGAL to diagnose acute kidney injury in AHF cannot be recommended at this time. (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin [N-GAL] Evaluation of Symptomatic Heart Failure Study [AKINESIS]; NCT01291836).