• Nattachai Srisawat, Passisd Laoveeravat, Ploynapas Limphunudom, Nuttha Lumlertgul, Sadudee Peerapornratana, Khajohn Tiranathanagul, Paweena Susantitaphong, Kearkiat Praditpornsilpa, Kriang Tungsanga, and Somchai Eiam-Ong.
• Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence center of Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: drnattachai@yahoo.com.
• J Crit Care. 2018 Feb 1; 43: 36-41.

PurposeThe 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.Material And MethodsThe 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≥400ng/mL (high pNGAL group) were randomized to 'early' or 'standard' group. Patients with pNGAL<400ng/mL (n=20) were defined as low pNGAL group.ResultsThe 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.ConclusionsOur 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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