Comparison of serum NGAL levels before and after hemodialysis in patients with Acute Renal Failure in the Emergency Department

Introduction: Acute Renal Failure (ARF) is the sudden decrease in kidney function. Acute kidney injury is common and life-threatening if proper treatment is not started. For this reason, new biomarkers have come to the fore for earlier detection of ARF, especially in emergency services. One of these new biomarkers is NGAL (neutrophil gelatinase-associated lipocalin), a protein also known as siderocalin, lipocalin 2, or oncogene 24p. Our aim in this study is to determine the value of serum NGAL levels in the diagnosis, clinical course and prognosis of ARF and to examine the change with hemodialysis. Material and methods: In this prospective, patients older than 18 years of age who applied to the Emergency Service of Samsun University Samsun Training and Research Hospital and received hemodialysis with the diagnosis of acute renal failure, and completely healthy individuals with similar demographic characteristics as the patient group were included. For the determination of NGAL levels, in addition to routine blood tests from the patient group, at 0 hour (NGAL-0), after hemodialysis at 1 hour (NGAL-1) and at 12 hours (NGAL 12); blood was drawn from the control group at a single time point. Serum NGAL levels were determined by ELISA method. The p<0.05 level was considered significant in the statistical evaluation of the recorded data. Results: A total of 72 cases, 44 in the patient group and 28 in the control group, were included in the study. The mean age of the patient group was 72.5±12.36 years, and the mean age of the control group was 67.54±12.83 years (p=0.106). 54.5% of the patient group and 46.4% of the control group were female (p=0.502). The median NGAL-0 level of the patient group was 1354.35 (30.23-2005.68), while the median NGAL-0 level of the control group was 40.72 (22.74-1702.8) (p<0.001). The median serum NGAL-1 value at the 1st hour after hemodialysis is 891.06 (30.27-2004,83) pg/µL, and the median serum NGAL-12 value at the 12th hour after hemodialysis is 711.25 (30.97-2003, 61) was determined as pg/µL. In the diagnosis of ARF, NGAL levels of 335.34 pg/µL and above were found to have 88.64% sensitivity and 85.71% specificity (AUC: 0.903; CI: 0,811-0,96 and p<0.001). NGAL (NGAL-0, 1, 12) levels of patients with and without mortality were similar (p>0.05). Conclusion: Serum NGAL measurement can be used to diagnose ARF, but it is not a useful parameter for the prognosis of the disease. Key words: Serum neutrophil gelatinase-associated lipocalin, acute kidney failure, hemodialysis