Open Access

Is neutrophil gelatinase-associated lipocalin unaffected by convective continuous renal replacement therapy? Definitely … maybe

  • Patrick M. Honore1Email author,
  • Rita Jacobs1,
  • Inne Hendrickx1,
  • Elisabeth De Waele1,
  • Viola Van Gorp1 and
  • Herbert D. Spapen1
Critical Care201519:392

https://doi.org/10.1186/s13054-015-1104-5

Published: 17 November 2015

The Letter to this article has been published in Critical Care 2016 20:20

Two recent studies published in Critical Care reported that plasma [1] and urinary [2] levels of neutrophil gelatinase-associated lipocalin (NGAL), an important biomarker for prediction and diagnosis of acute kidney injury, were not affected by continuous renal replacement therapy (CRRT).

The investigators assessed NGAL elimination during continuous venovenous hemofiltration [1] and hemodiafiltration [2] using respectively a cellulose triacetate [1] and a polysulfone [2] membrane filter. Of note is that these filters both have notoriously low adsorption capacity [3]. Recently, the proinflammatory high-mobility group box 1 protein, a cytokine with a molecular weight approximating that of NGAL, was also found to be unaffected by convective CRRT. However, it was significantly (up to 90 %!) cleared from the circulation when highly adsorptive membranes (i.e., surface-treated acrylonitrile 69 and polymethylmethacrylate) were used [4].

These membranes are increasingly applied for hemofiltration in critically ill patients [4]. Thus, it is imperative to evaluate NGAL clearance during convective CRRT performed with highly adsorptive membranes before definitively accepting that CRRT leaves the sensitivity of this biomarker intact.

Notes

Abbreviations

CRRT: 

Continuous renal replacement therapy

NGAL: 

Neutrophil gelatinase-associated lipocalin

Declarations

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel

References

  1. Schilder L, Nurmohamed SA, ter Wee PM, Paauw NJ, Girbes AR, Beishuizen A, et al. The plasma level and biomarker value of neutrophil gelatinase-associated lipocalin in critically ill patients with acute kidney injury are not affected by continuous venovenous hemofiltration and anticoagulation applied. Crit Care. 2014;18:R78.PubMedPubMed CentralView ArticleGoogle Scholar
  2. Vasileiadis I, Pipili C, Nanas S. Continuous renal replacement therapy in critically ill patients does not affect urinary neutrophil gelatinase-associated lipocalin levels. Crit Care. 2015;19:140.PubMedPubMed CentralView ArticleGoogle Scholar
  3. Honore PM, Jacobs R, Joannes-Boyau O, De Regt J, De Waele E, van Gorp V, et al. Newly designed CRRT membranes for sepsis and SIRS—a pragmatic approach for bedside intensivists summarizing the more recent advances: a systematic structured review. ASAIO J. 2013;59:99–106.PubMedView ArticleGoogle Scholar
  4. Yumoto M, Nishida O, Moriyama K, Shimomura Y, Nakamura T, Kuriyama N, et al. In vitro evaluation of high mobility group box 1 protein removal with various membranes for continuous hemofiltration. Ther Apher Dial. 2011;15:385–93.PubMedView ArticleGoogle Scholar

Copyright

© Honore et al. 2015

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