Distribution of urinary neutrophil gelatinase-associated lipocalin and post-translationally modified fetuin-A in outpatients with acute kidney disease detected using a nationwide automatic detection system

Background: Developing criteria for acute kidney disease (AKD) in the outpatient setting (AKD OPT ) remains challenging due to the fragmented interoperability of current health information systems.We introduced an acute kidney injury detection system (AKIDS) for AKD OPT within Taiwan's Cloud-based Health Information Exchange Platform to automate serum creatinine (S-Cre) monitoring.This study presented the distribution of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and post-translationally modified fragment of fetuin-A (uPTM-FetA) in patients with AKD OPT detected by the AKIDS and explored their association with composite kidney outcome (CKO).Methods: The Big Data Center of China Medical University Hospital in Taiwan established an AKD OPT cohort by consecutively enrolling patients referred to the nephrology clinic during a pragmatic trial to evaluate the clinical effectiveness of the AKIDS.Baseline and 3-month followup levels of uNGAL and uPTM-FetA were measured.The primary outcome was a CKO, namely end-stage kidney disease, S-Cre doubling, and an estimated glomerular filtration rate (eGFR) decline of >40 %.Results: A total of 98 patients with a median age of 71.4 (interquartile range: 63.4-78.0)years and a baseline median eGFR of 42.0 (27.3-53.7)mL/min/1.73m 2 were enrolled.Among those referred to the nephrology clinic with AKD OPT , 65.3 % and 61.2 % had baseline uPTM-FetA and uNGAL levels above the cutoff values (7.53 and 131.7 ng/mg, respectively).The median levels of