Neutrophil gelatinase-associated lipocalin (NGAL) reflects iron status in haemodialysis patients

Bolignano, Davide; Coppolino, Giuseppe; Romeo, Adolfo; Paola, Luciano De; Buemi, Antoine; Lacquaniti, Antonio; Nicocia, Giacomo; Lombardi, Luigi; Buemi, Michele

doi:10.1093/ndt/gfp310

Cited by 39 publications

(41 citation statements)

References 15 publications

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“…Anemia and inflammation are known to induce NGAL. 33,34 In this study, we could not demonstrate any association between serum NGAL levels and CRP. Serum NGAL levels were higher in HD patients compared with healthy controls in our study confirming the previous studies 33 probably due to decreased clearance rather than increased inflammation in HD patients.…”

contrasting

confidence: 77%

“…NGAL levels were found to be significantly correlated with transferrin saturation, ferritin and inversely associated with serum hepcidin levels in previous studies. 32,33 Thus, decreased NGAL levels may be considered to represent decreased iron availability in HD patients. However, in our study, serum NGAL levels were not associated with hepcidin or other serum iron parameters.…”

mentioning

confidence: 99%

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C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients

et al. 2015

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contrasting

confidence: 77%

mentioning

confidence: 99%

C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients

et al. 2015

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“…It follows that close monitoring of iron homeostasis is mandatory when sucroferric oxyhydroxide is administered to these subjects. On the other hand, CKD patients often show iron deficiency 63 and receive oral or intravenous iron supplementation. Several drug formulations are currently available, each of which is characterized by different iron content per pill (eg, ferrous gluconate: 300 mg, equivalent to 37.5 mg of elemental iron; ferrous sulfate: 329.7 mg, corresponding to 105 mg of elemental iron) and pharmacokinetic profile.…”

Section: Resultsmentioning

confidence: 99%

Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide

Cernaro

Santoro

Lacquaniti

et al. 2016

IJNRD

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Chronic kidney disease-mineral bone disorder is frequent in patients with renal failure. It is characterized by abnormalities in mineral and bone metabolism with resulting hyperphosphatemia, low serum vitamin D, secondary hyperparathyroidism, altered bone morphology and strength, higher risk of bone fractures, and development of vascular or other soft tissue calcifications. Besides the recommendation to reduce phosphorus dietary intake, many drugs are currently available for the treatment of calcium/phosphate imbalance. Among them, phosphate binders represent a milestone. Calcium-based binders (calcium carbonate, calcium acetate) are effective in lowering serum phosphate, but their use has been associated with an increased risk of hypercalcemia and calcifications. Calcium-free binders (sevelamer hydrochloride, sevelamer carbonate, and lanthanum carbonate) are equally or slightly less effective than calcium-containing compounds. They would not induce an increase in calcium levels but may have relevant side effects, including gastrointestinal symptoms for sevelamer and risk of tissue accumulation for lanthanum. Accordingly, new phosphate binders are under investigation and some of them have already been approved. A promising option is sucroferric oxyhydroxide (Velphoro ® , PA21), an iron-based phosphate binder consisting of a mixture of polynuclear iron(III)-oxyhydroxide, sucrose, and starches. The present review is focused on pharmacology, mode of action, and pharmacokinetics of sucroferric oxyhydroxide, with a discussion on comparative efficacy, safety, and tolerability studies of this drug in chronic kidney disease and patient perspectives such as quality of life, satisfaction, and acceptability. Sucroferric oxyhydroxide has proven to be as effective as sevelamer in reducing phosphatemia with a similar safety profile and lower pill burden. Experimental and clinical studies have documented a minimal percentage of iron absorption without inducing toxicity. In conclusion, the overall benefit-risk balance of sucroferric oxyhydroxide is deemed to be positive, and this new drug may therefore represent a good alternative to traditional phosphate binders for the treatment of hyperphosphatemia in dialysis patients.

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“…It may suggest a link between NGAL, iron metabolism, and inflammation. Bolignano et al [21] suggested that elevated NGAL was probably related to its involvement in iron equilibrium. They reported that NGAL was predicted by hsCRP, TSAT and spKt/V.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent issue of Nephrology Dialysis and Transplantation, Bolignano et al [21] suggested that altered NGAL values in haemodialysed patients were probably due to the fact that this protein was involved in iron metabolism. Since levels of hepcidin, a peptide known to be involved in iron metabolism [22], are also elevated in haemodialysed patients, in this study we tested the hypothesis whether NGAL might be correlated with hepcidin.…”

Section: Introductionmentioning

confidence: 99%

Possible Relationship between Neutrophil Gelatinase-Associated Lipocalin, Hepcidin, and Inflammation in Haemodialysed Patients

Małyszko

Kozminski³

et al. 2010

Nephron Clin Pract

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Background: Neutrophil gelatinase-associated lipocalin (NGAL) binds small, iron-carrying molecules – siderophores. On the other hand, hepcidin is a small defensin-like peptide produced by hepatocytes, modulated in response to anaemia, hypoxia, or inflammation. We tested the hypothesis that NGAL may be related to hepcidin, not only to iron metabolism, in 182 prevalent haemodialysed patients. Methods: Iron status (iron, total iron-binding capacity, ferritin, total saturation of transferrin, TSAT), complete blood count, creatinine, albumin, serum lipids were assessed using standard laboratory methods. Soluble receptor of transferrin, high-sensitivity C-reactive protein (hsCRP), tumour necrosis factor-α, interleukin-6, prohepcidin, hepcidin and NGAL were measured in serum using commercially available kits. Results: Serum NGAL, prohepcidin, hepcidin levels were significantly higher in haemodialysed patients over healthy volunteers (579.11 ± 213.95 vs. 78.43 ± 32.21 ng/ml, p < 0.001, 320.54 ± 182.65 vs. 98.65 ± 34.32 ng/ml, p < 0.01, 155.30 ± 94.05 vs. 23.65 ± 12.76 ng/ml, p < 0.001, respectively). Serum NGAL correlated strongly with residual renal function (r = –0.54, p < 0.001), Kt/V (r = 0.41, p < 0.001), hepcidin (r = –0.28, p < 0.01), serum creatinine (r = 0.63, p < 0.001), iron (r = 0.25, p < 0.01), TSAT (r = 0.30, p < 0.001), ferritin (r = 0.33, p < 0.001), hsCRP (r = 0.32, p < 0.001). In multiple regression analysis, residual renal function, hepcidin, creatinine and hsCRP were predictors of serum NGAL in haemodialysed patients. Conclusions: NGAL is highly induced in dialysed patients. NGAL could reflect both kidney function and iron metabolism. Taking into account the antimicrobial properties of NGAL, further studies are needed to address the role of NGAL in iron metabolism and inflammation in renal failure.

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Neutrophil gelatinase-associated lipocalin (NGAL) reflects iron status in haemodialysis patients

Abstract: The findings demonstrated that HD patients have altered NGAL values probably because this protein is involved in the maintenance of iron equilibrium. Finally, NGAL might be proposed as a new tool in the assessment of iron deficiency and in the management of iron therapy for HD patients.

Cited by 39 publications

References 15 publications

C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients

C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients

Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide

Possible Relationship between Neutrophil Gelatinase-Associated Lipocalin, Hepcidin, and Inflammation in Haemodialysed Patients

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