Work

Distribution of urinary neutrophil gelatinase-associated lipocalin and post-translationally modified fetuin-A in outpatients with acute kidney disease detected using a nationwide automatic detection system

Year: 2025

Type: article

Abstract: Background Developing criteria for acute kidney disease (AKD) in the outpatient setting (AKD OPT ) remains challenging due to the fragmented interoperability of current health information systems. We introduced an acute kidney injury detection system (AKIDS) for AKD OPT within Taiwan's Cloud-based Health Information Exchange Platform to automate serum creatinine (S-Cre) monitoring. This study presented the distribution of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and post-translationally modified fragment of fetuin-A (uPTM-FetA) in patients with AKD OPT detected by the AKIDS and explored their association with composite kidney outcome (CKO). Methods The Big Data Center of China Medical University Hospital in Taiwan established an AKD OPT cohort by consecutively enrolling patients referred to the nephrology clinic during a pragmatic trial to evaluate the clinical effectiveness of the AKIDS. Baseline and 3-month follow-up levels of uNGAL and uPTM-FetA were measured. The primary outcome was a CKO, namely end-stage kidney disease, S-Cre doubling, and an estimated glomerular filtration rate (eGFR) decline of >40 %. Results A total of 98 patients with a median age of 71.4 (interquartile range: 63.4–78.0) years and a baseline median eGFR of 42.0 (27.3–53.7) mL/min/1.73 m 2 were enrolled. Among those referred to the nephrology clinic with AKD OPT , 65.3 % and 61.2 % had baseline uPTM-FetA and uNGAL levels above the cutoff values (7.53 and 131.7 ng/mg, respectively). The median levels of uPTM-FetA and uNGAL increased to 88.4 (9.37–191) ng/mg and 1753 (299–3885) ng/mg, respectively, among patients experiencing CKOs. With Youden Index-derived cutoffs of 120 ng/mg for uPTM-FetA and 950 ng/mg for uNGAL, the adjusted odds ratios (aORs) for CKO in high-risk versus low-risk patients were 9.46 (95 % confidence interval [CI] 2.38–37.6, p = 0.001) for uPTM-FetA and 6.11 (1.75–21.4, p = 0.005) for uNGAL. Persistent elevation of uPTM-FetA was marginally associated with CKOs, with an aOR of 3.52 (95 % CI 0.86–14.4; p = 0.081). Conclusions The high proportion of elevated uNGAL and its positive association with CKO risk provide biological evidence to support the AKIDS's data algorithm in detecting AKD OPT . Similarly, uPTM-FetA demonstrated comparable characteristics to uNGAL in reflecting kidney injury in the context of AKD.

Source: Heliyon

DOI: 10.1016/j.heliyon.2025.e43550