Are Urinary Tubular Injury Markers Useful in Chronic Kidney Disease? A Systematic Review and Meta Analysis

Adverse outcome of chronic kidney disease, such as end stage renal disease, is a significant burden on personal health and healthcare costs. Urinary tubular injury markers, such as NGAL, KIM-1 and NAG, could provide useful prognostic value for the early identification of high-risk patients. However,...

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Bibliographic Details
Published in:PloS one 2016-12, Vol.11 (12), p.e0167334-e0167334
Main Authors: Zhou, Le-Ting, Lv, Lin-Li, Pan, Ming-Ming, Cao, Yu-Han, Liu, Hong, Feng, Ye, Ni, Hai-Feng, Liu, Bi-Cheng
Format: Article
Language:English
Subjects:
Atherosclerosis
Bioindicators
Biological markers
Biology and Life Sciences
Biomarkers
Biomarkers - urine
Communities
Confidence intervals
Diabetes
Epidemiology
Female
Health care
Hepatitis A Virus Cellular Receptor 1 - metabolism
Heterogeneity
Hospitals
Humans
Injuries
Kidney diseases
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - physiopathology
Kidney Failure, Chronic - urine
Kidney Tubules - injuries
Kidney Tubules - pathology
Lipocalin-2 - urine
Male
Mathematical models
Medical ethics
Medicine
Medicine and Health Sciences
Meta-analysis
Mortality
Neoplasm Proteins - urine
Nephrology
Neutrophils
Observational studies
Patients
Physical Sciences
Prognosis
Quality
Renal Insufficiency, Chronic - mortality
Renal Insufficiency, Chronic - physiopathology
Renal Insufficiency, Chronic - urine
Research and Analysis Methods
Risk assessment
Risk factors
Risk groups
Studies
Systematic review
Urine
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Summary:Adverse outcome of chronic kidney disease, such as end stage renal disease, is a significant burden on personal health and healthcare costs. Urinary tubular injury markers, such as NGAL, KIM-1 and NAG, could provide useful prognostic value for the early identification of high-risk patients. However, discrepancies between recent large prospective studies have resulted in controversy regarding the potential clinical value of these markers. Therefore, we conducted the first meta-analysis to provide a more persuasive argument to this debate. In the current meta-analysis, based on ten prospective studies involving 29366 participants, we evaluated the role of urinary tubular injury markers (NGAL, KIM-1 and NAG) in predicting clinical outcomes including CKD stage 3, end stage renal disease and mortality. The prognostic values of these biomarkers were estimated using relative risks and 95% confidence interval in adjusted models. All risk estimates were normalized to those of 1 standard deviation increase in log-scale concentrations to minimize heterogeneity. Fixed-effects models were adopted to combine risk estimates. The quality of the research and between-study heterogeneity were evaluated. The level of research evidence was identified according to the GRADE profiler. uNGAL was identified as an independent risk predictor of ESRD (pooled adjusted relative risk: 1.40[1.21 to 1.61], p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0167334