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Predictors of renal recovery in critically ill patients with AKI: observations from the ongoing FBI clinical trial

Introduction

The predictive value of NGAL for renal recovery is not established.

Methods

Data from the first 19 patients were assessed during a multicentre low molecular weight heparin trial (FBI, EudraCT Number: 2012-004368-23). Critically ill patients with AKI are randomly assigned into either a treatment arm (1 mg/kg enoxaparin) or a control arm (40 mg enoxaparin) upon commencement of CRRT. The primary outcome is the occurrence of venous thromboembolism. NGAL was measured at baseline and during CRRT-free intervals.

Results

Patients were comparable at baseline with respects to demographics, APACHE II, creatinine, NGAL, start of dialysis, and the duration of dialysis. The main cause of AKI was sepsis (42%). In 63% of the patients, the reason for starting dialysis was a combination of anuria and electrolyte disturbances. Twenty-six percent of patients were dialysis dependent after the first CRRT-free interval. Plasma NGAL levels were higher in nonrenal recovery patients (1,074 (±694) ng/ml) compared with renal recovery patients (296 (±197) ng/ml; P = 0.01). Urine NGAL levels were higher in nonrenal recovery patients (3,885 (±2,722) ng/ml) compared with renal recovery patients (597 (±565) ng/ ml; P = 0.006). See Figures 1 and 2. Inflammatory parameters (WBCs, CRP, and procalcitonin) did not differ significantly between the groups.

Figure 1
figure1

Plasma neutrophil gelatinase-associated lipocalin concentration by recovery.

Figure 2
figure2

Urine neutrophil gelatinase-associated lipocalin concentration by recovery.

Conclusion

NGAL may be able to predict renal recovery, and allow proper utilization of resources.

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Robinson, S., Larsen, U., Zincuk, A. et al. Predictors of renal recovery in critically ill patients with AKI: observations from the ongoing FBI clinical trial. Crit Care 19, P298 (2015). https://doi.org/10.1186/cc14378

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Keywords

  • Heparin
  • Enoxaparin
  • Venous Thromboembolism
  • Procalcitonin
  • Electrolyte Disturbance