Utility of Urine Neutrophil Gelatinase-Associated Lipocalin for Worsening Renal Function during Hospitalization for Acute Heart Failure: Primary findings for urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic heart faIlure Study (AKINESIS)

Abstract Background Worsening renal function (WRF) during acute heart failure (AHF) occurs frequently, and has been associated with adverse outcomes, though this association has been questioned. WRF is now evaluated by function and injury. We evaluated if urine Neutrophil Gelatinase-Associated Lipocalin (uNGAL) is superior to creatinine for prediction and prognosis of WRF in patients with AHF. Methods and Results Multicenter, international, prospective cohort of AHF patients requiring IV diuretics. Primary outcome was whether uNGAL predicted development of WRF, defined as a sustained increase in creatinine of 0.5 mg/dL or ≥50% above first value or initiation of renal replacement therapy, within the first five days. Main secondary outcome was a composite of in-hospital adverse events. 927 patients (age 68.5 years, 62% men) were enrolled. Primary outcome occurred in 72 patients (7.8%). Neither first, peak, nor the ratio of uNGAL to urine creatinine (area under curves (AUC) ≤ 0.613) had diagnostic utility over the first creatinine (AUC 0.662). There were 235 adverse events in 144 patients. uNGAL did not predict (AUCs ≤ 0.647) adverse clinical events better than creatinine (AUC 0.695). Conclusion uNGAL was not superior to creatinine for predicting WRF or adverse in-hospital outcomes, and cannot be recommended for WRF in AHF.