FGF-23 and PTH levels in patients with acute kidney injury: A cross-sectional case series study - PubMed (original) (raw)

doi: 10.1186/2110-5820-1-21.

Raymond Hsu, Chi-Yuan Hsu, Kristina Kordesch, Erica Nicasio, Alfredo Cortez, Ian McAlpine, Sandra Brady, Hanjing Zhuo, Kirsten N Kangelaris, John Stein, Carolyn S Calfee, Kathleen D Liu

Affiliations

FGF-23 and PTH levels in patients with acute kidney injury: A cross-sectional case series study

Maryann Zhang et al. Ann Intensive Care. 2011.

Abstract

Background: Fibroblast growth factor-23 (FGF-23), a novel regulator of mineral metabolism, is markedly elevated in chronic kidney disease and has been associated with poor long-term outcomes. However, whether FGF-23 has an analogous role in acute kidney injury is unknown. The goal of this study was to measure FGF-23 levels in critically ill patients with acute kidney injury to determine whether FGF-23 levels were elevated, as in chronic kidney disease.

Methods: Plasma FGF-23 and intact parathyroid hormone (PTH) levels were measured in 12 patients with acute kidney injury and 8 control subjects.

Results: FGF-23 levels were significantly higher in acute kidney injury cases than in critically ill subjects without acute kidney injury, with a median FGF-23 level of 1948 RU/mL (interquartile range (IQR), 437-4369) in cases compared with 252 RU/mL (IQR, 65-533) in controls (p = 0.01). No correlations were observed between FGF-23 and severity of acute kidney injury (defined by the Acute Kidney Injury Network criteria); among patients with acute kidney injury, FGF-23 levels were higher in nonsurvivors than survivors (median levels of 4446 RU/mL (IQR, 3455-5443) versus 544 RU/mL (IQR, 390-1948; p = 0.02). Severe hyperparathyroidism (defined as intact PTH >250 mg/dL) was present in 3 of 12 (25%) of the acute kidney injury subjects versus none of the subjects without acute kidney injury, although this result did not meet statistical significance.

Conclusions: We provide novel data that demonstrate that FGF-23 levels are elevated in acute kidney injury, suggesting that FGF-23 dysregulation occurs in acute kidney injury as well as chronic kidney disease. Further studies are needed to define the short- and long-term clinical effects of dysregulated mineral metabolism in acute kidney injury patients.

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Figures

Figure 1

Figure 1

PTH and FGF-23 levels in non-AKI and AKI subjects. A There was no overall difference in PTH levels between AKI and non-AKI subjects (p = 0.73). B FGF-23 levels were significant higher in patients with AKI compared with non-AKI subjects (p = 0.01).

Figure 2

Figure 2

Correlation of serum phosphorus (PO4) and FGF-23 levels in patients with and without acute kidney injury. No correlation was observed between PO4 and FGF-23 levels (r = 0.08, p = 0.74).

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