Abstract:
Screening approaches with more robust biomarkers, are of the utmost importance in the
characterization of renal injuries, particularly among communities with high burdens of chronic
kidney disease of uncertain etiology (CKDu). The present study aimed to assess the utility of
two emerging biomarkers: kidney injury molecule (KIM-1) and neutrophil gelatinase-associated
lipocalin (NGAL) in predicting renal injury in different occupational groups in Sri Lanka. A crosssectional
study was conducted with six occupational groups (n = 188): fisherfolk (FF), paddy farmers
(PF), sugarcane farmers (SF), factory workers (FW) and plantation workers (PW) to assess the
predictive performance of KIM-1 and NGAL against a CKDu patient (PT) group (n = 40). The median
KIM-1 levels of the study groups; FF, PF, SF, FW, PW and PT were 0.67, 0.59, 0.49, 1.62, 0.67 and
5.24 ng/mgCr, respectively, while the median NGAL levels were 1.16, 2.52, 1.42, 1.71, 1.06 and
22.41 ng/mgCr respectively. In ROC analysis to predict CKDu susceptibility, the area under the
curve for KIM-1 ranged from 0.88 to 0.99 for the study groups, and in overall analysis, the sensitivity
and specificity were 100% and 96%, respectively, for a cutoff value of 2.76 ng/mgCr. Similarly,
for NGAL the range of AUC was 0.78–0.94, and a cutoff value of 3.12 ng/mgCr produced 88%
sensitivity and 82% specificity. Compared with conventional markers, KIM-1 was the best biomarker
for the characterization of renal injury in the participants of the occupational groups. With further
validations, KIM-1 may be adopted as a prognostic marker to identify early renal injury and CKDu
susceptibilities in community screening.
