Circulating neutrophil gelatinase-associated lipocalin (NGAL) is associated with markers of chronic kidney disease mineral bone disorders (CKD-MBD) in patients receiving hemodialysis, a new study finds.

“These findings suggest that NGAL is a participant in CKD-MBD under [maintenance hemodialysis] conditions,” Dong‑mei Xu, MD, and colleagues from The First Affiliated Hospital of Shandong First Medical University in Jinan, China, wrote in the Journal of Bone and Mineral Metabolism.

Plasma NGAL positively and significantly correlated with serum calcium, phosphate, and alkaline phosphatase (ALP) in adjusted analyses of data from 105 patients receiving hemodialysis, the investigators reported. Further, 12 patients who underwent parathyroidectomy with autotransplantation (PTx +AT) for severe secondary hyperparathyroidism saw their plasma NGAL decrease from 715.84 to 688.42 ng/mL within a week of surgery, albeit nonsignificantly.

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The investigators adjusted for a range of possible confounders, including age, sex, dialysis vintage, albumin, and parameters of CKD-MBD (calcium, phosphate, ALP, intact parathyroid hormone, Klotho, and fibroblast growth factor 23).

The positive correlations between circulating NGAL and ALP, calcium, and decline in NGAL after PTx + AT “suggested that bone may be one of the main sources of increased NGAL in [maintenance hemodialysis] patients.”

The study lacked data on bone mineral density and vascular calcification and CKD-MBD sequelae, such as fracture, cardiovascular disease, and death. The investigators suggested examining these variables in future research.

“To our knowledge, this is the first study to find an association between NGAL and ALP in patients [receiving maintenance hemodialysis], and this finding suggests NGAL may be important for the increasingly known crosstalk between bone and vessels.”


Jia XY, Wei K, Chen J, et al. Association of plasma neutrophil gelatinase‑associated lipocalin with parameters of CKD-MBD in maintenance hemodialysis patients. J Bone Miner Metab. Published online August 15, 2021. doi:10.1007/s00774-021-01248-9