Original Article

Pediatric Nephrology

, Volume 28, Issue 6, pp 959-962

First online:

Preoperative plasma FGF23 levels predict acute kidney injury in children: results of a pilot study

  • Farah N. AliAffiliated withKidney Diseases, Lurie Children’s Hospital Email author 
  • , Amanda HassingerAffiliated withIntensive Care Medicine, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine
  • , Heather PriceAffiliated withKidney Diseases, Lurie Children’s Hospital
  • , Craig B. LangmanAffiliated withKidney Diseases, Lurie Children’s Hospital

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Acute kidney injury (AKI) carries a large burden of morbidity and mortality. Early diagnosis may lead to better strategies of clinical care. Cardiac surgery involving cardiopulmonary bypass is associated with a significant incidence of AKI. The study objective was to determine whether or not preoperative fibroblast growth factor-23 (FGF23) levels differed among pediatric patients who did or did not develop AKI following cardiac surgery.


A nested case–control study was performed. FGF23 levels were measured pre- and post-operatively in 19 children without chronic kidney disease (CKD) who underwent cardiopulmonary bypass. Five patients developed AKI and 14 patients served as controls.


FGF23 levels in patients who developed AKI following cardiac surgery were elevated above normal levels, both pre-operatively and post-operatively compared with those patients who did not develop AKI. Relative risk of developing AKI when the pre-operative FGF23 level was >86 RU/mL was 2.0 (p = 0.033). Preoperative FGF23 levels correlated with post-operative fluid gain (correlation coefficient 0.607, p = 0.0059).


FGF23 may serve as a pre-operative prognostic indicator of the development of AKI following cardiopulmonary bypass surgery in pediatric patients without CKD. Identifying patients more likely to have AKI following surgery provides a means of achieving closer clinical management of AKI and fluid balance.


Acute kidney injury Biomarkers Cardiopulmonary bypass Children FGF23 Prognosis