FGF-23 and PTH levels in patients with acute kidney injury A cross-sectional case series study.docVIP

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FGF-23 and PTH levels in patients with acute kidney injury A cross-sectional case series study.doc

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FGF-23 and PTH levels in patients with acute kidney injury A cross-sectional case series study

Zhangetal.AnnalsofIntensiveCare2011,1:21 /content/1/1/21 RESEARCH OpenAccess FGF-23andPTHlevelsinpatientswithacute kidneyinjury:Across-sectionalcaseseriesstudy MaryAnnZhang1,RaymondHsu2,Chi-yuanHsu2,KristinaKordesch3,EricaNicasio3,AlfredoCortez4,IanMcAlpine4, SandraBrady3,HanjingZhuo3,KirstenNKangelaris5,JohnStein4,CarolynSCalfee6andKathleenDLiu2* Abstract Background:Fibroblastgrowthfactor-23(FGF-23),anovelregulatorofmineralmetabolism,ismarkedlyelevated inchronickidneydiseaseandhasbeenassociatedwithpoorlong-termoutcomes.However,whetherFGF-23has ananalogousroleinacutekidneyinjuryisunknown.ThegoalofthisstudywastomeasureFGF-23levelsin criticallyillpatientswithacutekidneyinjurytodeterminewhetherFGF-23levelswereelevated,asinchronic kidneydisease. Methods:PlasmaFGF-23andintactparathyroidhormone(PTH)levelsweremeasuredin12patientswithacute kidneyinjuryand8controlsubjects. Results:FGF-23levelsweresignificantlyhigherinacutekidneyinjurycasesthanincriticallyillsubjectswithout acutekidneyinjury,withamedianFGF-23levelof1948RU/mL(interquartilerange(IQR),437-4369)incases comparedwith252RU/mL(IQR,65-533)incontrols(p=0.01).NocorrelationswereobservedbetweenFGF-23and severityofacutekidneyinjury(definedbytheAcuteKidneyInjuryNetworkcriteria);amongpatientswithacute kidneyinjury,FGF-23levelswerehigherinnonsurvivorsthansurvivors(medianlevelsof4446RU/mL(IQR,3455- 5443)versus544RU/mL(IQR,390-1948;p=0.02).Severehyperparathyroidism(definedasintactPTH250mg/dL) waspresentin3of12(25%)oftheacutekidneyinjurysubjectsversusnoneofthesubjectswithoutacutekidney injury,althoughthisresultdidnotmeetstatisticalsignificance. Conclusions:WeprovidenoveldatathatdemonstratethatFGF-23levelsareelevatedinacutekidneyinjury, suggestingthatFGF-23dysregulationoccursinacutekidneyinjuryaswellaschronickidneydisease.Further studiesareneededtodefinetheshort-andlong-termclinicaleffectsofdysregulatedmineralmetabolisminacute kidneyinjurypatients. Introduction alteredmineralmetabolism–likelyoccurinAKIpatients, Acute kidney inj