NYMC Faculty Publications
Fibroblast Growth Factor 23 Levels Associate with AKI and Death in Critical Illness
DOI
10.1681/ASN.2016080836
Journal Title
Journal of the American Society of Nephrology : JASN
First Page
1877
Last Page
1885
Document Type
Article
Publication Date
June 2017
Department
Medicine
Abstract
Elevated plasma levels of the osteocyte-derived hormone fibroblast growth factor 23 (FGF23) have emerged as a powerful biomarker of cardiovascular disease and death in patients with CKD. Whether elevated urinary or plasma FGF23 levels are prospectively associated with AKI and death in critically ill patients is unknown. We therefore conducted a prospective cohort study of 350 critically ill patients admitted to intensive care units at an academic medical center to investigate whether higher urinary FGF23 levels associate with the composite end point of AKI or in-hospital mortality (AKI/death). We measured urinary FGF23 levels within 24 hours of admission to the intensive care unit. In a subcohort (n=131) we also measured plasma levels of FGF23, calcium, phosphate, parathyroid hormone, and vitamin D metabolites. Urinary and plasma FGF23 levels, but not other mineral metabolites, significantly associated with AKI/death. In multivariate analyses, patients in the highest compared with the lowest quartile of urinary FGF23 had a 3.9 greater odds (95% confidence interval, 1.6 to 9.5) of AKI/death. Higher urinary FGF23 levels also independently associated with greater hospital, 90-day, and 1-year mortality; longer length of stay; and several other important adverse outcomes. In conclusion, elevated FGF23 levels measured in the urine or plasma may be a promising novel biomarker of AKI, death, and other adverse outcomes in critically ill patients.
Recommended Citation
Leaf, D., Jacob, K., Srivastava, A., Chen, M., Christov, M., Juppner, H., Sabbisetti, V., Martin, A., Wolf, M., & Waikar, S. (2017). Fibroblast Growth Factor 23 Levels Associate with AKI and Death in Critical Illness. Journal of the American Society of Nephrology : JASN, 28 (6), 1877-1885. https://doi.org/10.1681/ASN.2016080836