Clinical Value of NGAL, L-FABP and Albuminuria in Predicting GFR Decline in Type 2 Diabetes Mellitus Patients

<div><h3>Objectives</h3><p>Neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid binding protein (L-FABP) are emerging as excellent biomarkers in the urine and plasma for the early prediction of acute and chronic kidney injury. The aims of this prospective study were to determine the role of albuminuria, and that of serum and urine levels of NGAL and L-FABP as predictors of a decline in the glomerular filtration rate (GFR) in patients with type 2 diabetes.</p> <h3>Methods</h3><p>A longitudinal cohort study with one hundred forty type 2 diabetic patients was conducted. Serum and urine levels of NGAL and L-FABP, and the urine albumin excretion rate were determined. The correlation between the kidney injury biomarkers and rate of GFR decline was analyzed.</p> <h3>Results</h3><p>The eGFR of study subjects decreased significantly as the study progressed (86.4±31.1 <em>vs</em>. 74.4±27.3 ml/min/1.73 m², <em>P</em><0.001), and the urine albumin excretion rate increased significantly (264.9±1060.3 <em>vs</em>. 557.7±2092.5 mg/day, <em>P</em> = 0.009). The baseline urine albumin excretion rate and serum L-FABP level were significantly correlated with baseline eGFR (<em>P</em><0.05). The results of regression analysis for the correlations between the rate of eGFR change and the baseline levels of NGAL and L-FABP, and the urine albumin excretion rate showed that only the urine albumin excretion rate was significantly correlated with the rate of eGFR change (standardized coefficients: −0.378; t: −4.298; <em>P</em><0.001).</p> <h3>Conclusions</h3><p>Tubular markers, such as NGAL and L-FABP, may not be predictive factors associated with GFR decline in type 2 diabetic patients.</p> </div

Pearson correlation between the rate of eGFR decline and the baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP, and the urine albumin excretion rate.

<p>Pearson correlation between the rate of eGFR decline and the baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP, and the urine albumin excretion rate.</p

Correlation between baseline eGFR and the baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP, and the daily urine albumin amount.

<p>Spearman's rank correlation coefficient analysis results.</p

Distribution of eGFR in study subjects.

<p>Distribution of eGFR in study subjects.</p

General characteristics and laboratory data of study subjects.

<p>Abrreviations:</p><p>DM: diabettes mellitus.</p><p>SBP: systolic blood pressure.</p><p>DBP: diastolic blood pressure.</p><p>BMI: body mass index.</p><p>HbA1c: glycated hemoglobin.</p><p>HDL: high-density lipoprotein.</p><p>LDL: low-density lipoprotein.</p><p>HS-CRP: highly sensitive C-reactive protein.</p><p>eGFR: estimated glomerular filtration rate.</p><p>NGAL: neutrophil gelatinase-associated lipocalin.</p><p>L-FABP: liver-type fatty acid-binding protein.</p><p>ACEI: angiotensin-converting-enzyme inhibitor.</p><p>ARB: angiotensin receptor blocker.</p

Correlation between the rate of eGFR decline and the baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP, and the urine albumin excretion rate.

<p>Spearman's rank correlation coefficient analysis results.</p

Correlation between baseline eGFR and the baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP, and the daily urine albumin amount.

<p>Multiple regression analysis results. <b>B:</b> Spearman's rank correlation coefficient analysis.</p

Pearson correlation between baseline eGFR and baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP and the daily urine albumin amount.

<p>Pearson correlation between baseline eGFR and baseline levels of serum NGAL, serum L-FABP, urine NGAL, and urine L-FABP and the daily urine albumin amount.</p

Distribution of albuminuria in study subjects.

<p>Distribution of albuminuria in study subjects.</p

Ferric citrate reduces the need for intravenous iron and ESA.

(A) Intravenous iron dosage and administration. (B) ESA dosage and use. (JPG)</p