NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) AS A BIOMARKER OF IRON DEFICIENCY AMONG EGYPTIAN HAEMODIALYSIS PATIENTS

Objectives: Evaluation of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in a small cohort of patients in order to assess any relationships it may have with the iron balance, and its utility as a biomarker of iron deficiency.

Methods: This cross sectional study of 80 regular haemodialysis (HD) patients (51 males and 29 females) selected from dialysis units of Eldakahlia hospitals. The study was done over a period of one year. All patients were on fixed dose of recombinant erythropoietin therapy for at least 6 weeks and none received intravenous iron administration or packed red cell transfusion during the 2 months preceding the start of the study. Patients were divided into two groups; Group (1): - Patients with transferrin saturation (TSAT) < 30% considerd as iron deficient group, Group (2):- Patients with TSAT > 30% considered as iron repleted group. NGAL was measured in the serum using the (Enzyme Linked Immunosorbant Assay) ELISA commercially available kit (NOVA) bioneovan company, China according to the manufacture`s instruments and its level was expressed as ng/ml.

Results: NGAL levels were significantly higher in HD patients compared to control non HD group. HD patients with TSAT <30% had lower NGAL values than HD patients with TSAT >30%. In Receiver operating characteristics (ROC) analysis for identifying iron deficiency, the plasma NGAL (best cut-off value ≤ 51.893 ng/ml) was superior to the serum ferritin (suggested cut-off value ≤ 500 ng/ ml) in both sensitivity and specificity.

Conclusion: Plasma NGAL is associated with iron status in HD patients. Finally, NGAL might be proposed as a new tool in the assessment of iron deficiency useful in the management of iron therapy for HD patients but further studies are needed to demonstrate the role of plasma NGAL in assessing the iron deficiency and in guiding the iron therapy for HD patients.