Fibroblast growth factor 23 levels are elevated and associated with severe acute kidney injury and death following cardiac surgery.
Fibroblast growth factor 23 levels are elevated and associated with severe acute kidney injury and death following cardiac surgery.
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DOI：
10.1016/j.kint.2015.12.035
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发表时间：
2016-04
影响因子：
19.6
通讯作者：
Waikar SS
中科院分区：
文献类型：
--
作者：
Leaf DE;Christov M;Jüppner H;Siew E;Ikizler TA;Bian A;Chen G;Sabbisetti VS;Bonventre JV;Cai X;Wolf M;Waikar SS
成纤维细胞生长因子23（FGF 23）在慢性肾脏疾病中升高，并与死亡率增加相关，但关于FGF 23在急性肾损伤（阿基）患者中的数据有限。在这里，我们测试了心脏手术后阿基早期FGF 23水平是否升高，以及术后较高的FGF 23水平是否与严重阿基和不良结局独立相关。在250例接受心脏手术的患者中，在术前、体外循环结束时以及术后第1天和第3天测量血浆C-末端FGF 23（cFGF 23）水平。我们还测量了18例重度阿基患者和18例匹配的非AKI对照者的完整FGF 23（iFGF 23）、甲状旁腺激素、磷酸盐和维生素D代谢产物。从心肺转流术结束时开始，与未发生AKI的患者相比，发生AKI的患者的cFGF 23水平显著且持续较高。早期cFGF 23的增加早于其他矿物质代谢产物的变化。iFGF 23的水平在发生严重阿基的患者中也增加，但幅度低于cFGF 23。在校正了年龄、术前eGFR和心肺转流时间的分析中，心肺转流结束时较高的cFGF 23水平与重度阿基的风险较高以及需要肾脏替代治疗或死亡显著相关。因此，cFGF 23水平在心脏手术后阿基中早期升高，并且与不良术后结局独立相关。
Fibroblast growth factor 23 (FGF23) is elevated in chronic kidney disease and associated with increased mortality, but data on FGF23 in humans with acute kidney injury (AKI) are limited. Here we tested whether FGF23 levels rise early in the course of AKI following cardiac surgery, and if higher postoperative FGF23 levels are independently associated with severe AKI and adverse outcomes. Plasma C-terminal FGF23 (cFGF23) levels were measured preoperatively, at the end of cardiopulmonary bypass, and on postoperative days 1 and 3 in 250 patients undergoing cardiac surgery. We also measured intact FGF23 (iFGF23), parathyroid hormone, phosphate, and vitamin D metabolites in a subgroup of 18 patients with severe AKI and 18 matched non-AKI controls. Beginning at the end of cardiopulmonary bypass, cFGF23 levels were significantly and consistently higher in patients who developed AKI compared to those who did not. The early increase in cFGF23 predated changes in other mineral metabolites. The levels of iFGF23 also increased in patients who developed severe AKI, but the magnitude was lower than cFGF23. In analyses adjusted for age, preoperative eGFR, and cardiopulmonary bypass time, higher cFGF23 levels at the end of cardiopulmonary bypass were significantly associated with greater risk of severe AKI and the need for renal replacement therapy or death. Thus, cFGF23 levels rise early in AKI following cardiac surgery, and are independently associated with adverse postoperative outcomes.