Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jo S, Rosner M, Okusa M (2007) Pharmacologic treatment of acute kidney injury: why drugs haven’t worked and what is on the horizon. Clin J Am Soc Nephrol 2:356–365
Andreoli S (2009) Acute kidney injury in children. Pediatr Nephrol 24:253–263
Zappitelli M (2008) Epidemiology and diagnosis of acute kidney injury. Semin Nephrol 28:436–446
Devarajan P (2005) Cellular and molecular derangements in acute tubular necrosis. Curr Opin Pediatr 17:193–199
Symons J, Chua A, Somers M, Baum M, Bunchman T, Benfield M, Brophy P, Blowey D, Fortenberry J, Chand D, Flores F, Hackbarth R, Alexander S, Mahan J, McBryde K, Goldstein S (2007) Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol 2:732–738
Ali F, Lane J (2012) Hemofiltration circuit use beyond 72 hours in pediatric continuous renal replacement therapy. Int J Artif Organs 35:139–143
Goldstein S, Currier H, Graf C, Cosio C, Brewer E, Sachdeva R (2001) Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 107:1309–1312
Goldstein S, Somers M, Baum M, Symons J, Brophy P, Blowey D, Bunchman T, Baker C, Mottes T, McAfee N, Barnett J, Morrison G, Rogers K, Fortenberry J (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67:653–658
Fargason C, Langman C (1993) Limitations of the pediatric risk of mortality score in assessing children with acute renal failure. Pediatr Nephrol 7:703–707
Annual Data Report. U.S. Renal Data Systems (2006) (available from http://www.usrds.org/atlas06.aspx)
Coca S, Yusuf B, Shlipak M, Garg A, Parikh C (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53:961–973
Gutierrez O, Januzzi J, Isakova T, Laliberte K, Smith K, Collerone G, Sarwar A, Hoffmann U, Coglianese E, Christenson R, Wang T, deFilippi C, Wolf M (2009) Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease. Circulation 119:2545–2552
Jean G, Terrat J, Vanel T, Hurot J, Lorriaux C, Mayor B, Chazot C (2009) High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients. Nephrol Dial Transplant 24:2792–2796
Liu P, Bai X, Wang H, Karaplis A, Goltzman D, Miao D (2009) Hypophosphatemia-mediated hypotension in transgenic mice overexpressing human FGF-23. Am J Physiol Heart Circ Physiol 297:H1514–H1520
Gutierrez O, Mannstadt M, Isakova T, Rauh-Hain J, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Juppner H, Wolf M (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359:584–592
Hassinger A, Backer C, Lane J, Haymond S, Wang D, Wald E (2012) Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery. Pediatr Crit Care Med 13:435–440
Isakova T, Wahl P, Vargas G, Gutierrez O, Scialla J, Xie H, Appleby D, Nessel L, Bellovich K, Chen J, Hamm L, Gadegbeku C, Horwitz E, Townsend R, Anderson C, Lash J, Hsu C, Leonard M, Wolf M (2011) Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. Kidney Int 79:1370–1378
Zhang M, Hsu R, Hsu C, Kordesch K, Nicasio E, Cortez A, McAlpine I, Brady S, Zhuo H, Kangelaris K, Stein J, Calfee C, Liu K (2011) FGF-23 and PTH levels in patients with acute kidney injury: a cross-sectional case series study. Ann Intensive Care 1:21
Leaf D, Wolf M, Waikar S, Chase H, Christov M, Cremers S, Stern L (2012) FGF-23 levels in patients with AKI and risk of adverse outcomes. Clin J Am Soc Nephrol 7:1217–1223
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ali, F.N., Hassinger, A., Price, H. et al. Preoperative plasma FGF23 levels predict acute kidney injury in children: results of a pilot study. Pediatr Nephrol 28, 959–962 (2013). https://doi.org/10.1007/s00467-012-2395-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-012-2395-2