NGAL has been identified as a powerful early predictor of WRF in a number of different clinical settings , although the data in AHF are conflicting . Similarly to Breidthardt et al. , we found modest predictive ability for plasma NGAL, which provided minimal improvement on top of creatinine for predicting WRF. Our data further confirm findings by the prospective biomarker study Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study (AKINESIS) that recently showed similar results—NGAL was not a more sensitive predictor of AKI in patients admitted with acute HF . Whereas AKINESIS only assessed severe and sustained increases in creatinine, more closely resembling acute kidney injury, we evaluated the much more common used definitions of WRF. Furthermore, our study not only provides data on inhospital changes in plasma NGAL, but also long term outcomes, whereas in AKINESIS only inhospital events were evaluated. In the end, considering the poor performance of both markers for AKI/WRF prediction in both AKINESIS and the present study, the clinical relevance of the associations is debatable at best.