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The optimal time and the parameter utilized for decision to initiate renal replacement therapy (RRT) in acute kidney injury (AKI) are still controversial. Recently, high levels of plasma NGAL (pNGAL) has been strongly correlated with poor AKI outcome. This is a feasibility study conducted to test whether early RRT initiation guided by pNGAL could improve AKI outcome.The study comprised of triage trial and interventional trial running subsequently. As a guide for triage to RRT, we measured pNGAL at the enrollment time. Forty patients with pNGAL ≥ 400 ng/mL (high pNGAL group) were randomized to ‘early’ or ‘standard’ group. Patients with pNGAL < 400 ng/mL (n = 20) were defined as low pNGAL group.The triggering pNGAL selected AKI patients with more severity of illness and worse clinical outcome. However, in high pNGAL group, early RRT did not result in different 28-day mortality from the standard group. The median numbers of day free from mechanical ventilation were significantly higher in the early RRT group.Our finding suggested that it was feasible to use pNGAL to triage severe AKI patients. However, early initiation of RRT in this high risk group did not affect the 28-day mortality.The first feasibility study using plasma NGAL triaged severe AKI patients for early initiation of renal replacement therapy.High plasma NGAL at the cut-off point 400 ng/mL had shown the association with the worse AKI outcomes.Early RRT strategy has shown comparable 28 day-mortality to standard RRT strategy in this feasibility study.