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Fibroblast Growth Factor 23 Levels Associate with AKI and Death in Critical Illness

David E Leaf1, Kirolos A Jacob2, Anand Srivastava3

  • 1Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; DELEAF@partners.org.

Journal of the American Society of Nephrology : JASN
|December 29, 2016
PubMed

Insights

Elevated fibroblast growth factor 23 (FGF23) in urine or plasma may predict acute kidney injury (AKI) and death in critically ill patients. Higher FGF23 levels are linked to increased mortality and adverse outcomes.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Endocrinology

Background:

  • Fibroblast growth factor 23 (FGF23) is an osteocyte-derived hormone linked to cardiovascular disease in chronic kidney disease (CKD).
  • The association between FGF23 levels and acute kidney injury (AKI) or mortality in critically ill patients remains unclear.

Purpose of the Study:

  • To investigate the prospective association between urinary and plasma FGF23 levels and the composite endpoint of AKI or in-hospital mortality in critically ill patients.
  • To determine if FGF23 is a useful biomarker for adverse outcomes in the intensive care unit (ICU).

Main Methods:

  • A prospective cohort study of 350 critically ill patients admitted to an ICU.
  • Urinary FGF23 levels were measured within 24 hours of ICU admission.
  • Plasma FGF23 and other mineral metabolites were measured in a subcohort (n=131).

Main Results:

  • Elevated urinary and plasma FGF23 levels, but not other mineral metabolites, were significantly associated with AKI/death.
  • Patients in the highest quartile of urinary FGF23 had a 3.9-fold greater odds of AKI/death.
  • Higher urinary FGF23 levels independently predicted increased hospital, 90-day, and 1-year mortality, longer hospital stay, and other adverse outcomes.

Conclusions:

  • Elevated FGF23 levels in urine or plasma may serve as a novel and promising biomarker for AKI, mortality, and adverse outcomes in critically ill patients.
  • FGF23 warrants further investigation as a prognostic tool in critical care settings.

Keywords:
acute renal failureclinical nephrologymortality riskparathyroid hormonevitamin D

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