MON-222 URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (nGAL) IN EARLY ACUTE KIDNEY INJURY (AKI) PREDICTS PROGRESSION AND NEED FOR DIALYSIS

Abstract

Predicting the progression of acute kidney injury (AKI) and need for renal replacement therapy (RRT) in early stages of AKI would be a useful bedside tool for clinicians, especially in resource-limited countries to optimize resource utilisation. We tested the predictive value of urine neutrophil gelatinase-associated lipocalin (NGAL) measured in the AKI stages 1 and 2, to predict progression of AKI and need for RRT. We analysed 288 patients of AKI diagnosed based on KDIGO criteria, who had measurement of urine NGAL (uNGAL) in AKI stages 1 (n=202) and 2 (n=86), admitted to a tertiary care hospital in South India. The progression of AKI was defined as the progression to a higher stage of AKI with a rise of at least 0.5 mg/dl in serum creatinine from the time of measurement of uNGAL or need for RRT. The outcomes studied were progression of AKI, need for RRT and hospital mortality. The mean age was 61.5±13.4 years and 78% were males. Sixty-two patients (21.5%) had progression of AKI, 55(19%) required RRT and hospital mortality was seen in 77(27%). The uNGAL (ng/ml) was 1778±2325 in progressive AKI and 399±1019 in non-progressive AKI patients (p<0.001). Similarly, uNGAL (ng/ml) was 1921±2432 in patients who ultimately received RRT and was 408±1007 in patients who did not receive RRT (p<0.001). The area under the curve (AUC) of receiver operating characteristic curve (ROC) for uNGAL to predict progression of AKI was 0.79 and to predict the need for RRT was 0.78. The cut-off uNGAL value of 1000 ng/ml to predict progression of AKI had sensitivity of 49.2% and specificity of 90.2%, whereas to predict need for RRT, the sensitivity was 52% and specificity was 90%. Strengths: Ours is a large study from a developing country, where AKI demography may be different from developed countries. Limitations: Ours is a single center study and needs validation from other centers in developing countries. Urine NGAL, when measured in early stages of AKI, was a strong predictor of progression of AKI and need for RRT. A cut-off uNGAL value of 1000 ng/ml is a reliable specific marker of progression of AKI and requirement of RRT when measured in AKI stages 1 and 2.