Fibroblast growth factor-23 as a predictor biomarker of acute kidney injury after cardiac surgery

Abstract

Renal ischemia/reperfusion injury is a major cause of acute kidney injury (AKI). The lack of early biomarkers for predicting AKI has hampered our ability to initiate preventive and therapeutic measures in an opportune way. Fibroblast growth factor 23 (FGF-23) is elevated in chronic kidney disease, but data on FGF-23 in humans with AKI are limited. Herein, we tested whether FGF-23 levels rise early in the course of AKI following cardiac surgery. We prospectively evaluated eighty adult patients who underwent cardiac surgery. Patients were divided into two groups (AKI and non-AKI group) on the basis of whether they developed postoperative AKI within 24 h after surgery. Plasma FGF-23 levels were measured before surgery and 24 h after surgery. The primary outcome was AKI diagnosed using the AKI Network criteria. Forty-five patients (56.2.5%) developed AKI after surgery. Plasma FGF-23 increased significantly from a mean of 26.8 ± 2.47 ng/mL at baseline to 341.7 ± 38.1 ng/mL 24 h after cardiopulmonary bypass. Univariate analysis showed a significant correlation between AKI and the following: percent change in plasma FGF-23, postoperative serum level of creatinine, FGF-23, and neutrophil gelatinase-associated lipocalin. Receiver operating characteristic curve analysis revealed that, for percent change in plasma FGF-23 concentrations at 24 h, the area under the curve was 0.9, sensitivity was 100%, and specificity was 97.1%. Plasma FGF-23 percent change is more valid compared with FGF-23 before or after procedure in the prediction of AKI and represents a novel and highly predictive early biomarker for AKI after cardiac surgery.

Baseline Serum Cystatin C Is a Potential Predictor for Acute Kidney Injury in Patients with Acute Pancreatitis

“…Multiple new molecular markers have been found to predict AKI in patients at the early stage. Shaker et al found that plasma fibroblast growth factor-23 (FGF-23) was a novel and highly predictive early biomarker for AKI after cardiac surgery [25]. Pang et al found that urinary KIM-1 and urinary NGAL could efficiently discriminate patients with and without vancomycin-associated AKI earlier than serum Cr [26].…”

Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD

“…Urinary liver fatty acid-binding protein and plasma fibroblast growth factor-23 are new and highly predictive early biomarkers for AKI following cardiac surgery. 16 , 17 Further, urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary kidney injury molecule-1 could efficiently predict vancomycin-associated AKI earlier than SCr. 18 Cystatin C, measured on day 3 of life, can predict AKI earlier than SCr and estimated GFR in neonates with respiratory distress syndrome 19 ; however, which biomarkers can predict AKI in patients with AECOPD remains unclear.…”

Research progress of fibroblast growth factor 23 in acute kidney injury

“…Rygasiewicz et al [41] conducted a cohort study of 79 ICU patients and revealed that cFGF23 concentrations above 136 RU/mL measured within 24 h of ICU admission were able to predict AKI with an area under the curve (AUC) of 0.81 (sensitivity 83% and specificity 82%). Shaker et al [42] detected plasma iFGF23 in 80 adult patients who underwent cardiac surgery and reported that percent change of FGF23 > 435% measured before and 24 h after surgery could predict the occurrence of AKI (AUC 0.9, sensitivity 100%, and specificity 97.1%). Other studies have confirmed the predictive value of FGF23 in AKI diagnosis (Table 1).…”