Division of Nephrology, Department of Medicine, University of California, San Francisco, CA, USA.
Ann Intensive Care. 2011 Jun 14;1(1):21. doi: 10.1186/2110-5820-1-21.
Fibroblast growth factor-23 (FGF-23), a novel regulator of mineral metabolism, is markedly elevated in chronic kidney disease and has been associated with poor long-term outcomes. However, whether FGF-23 has an analogous role in acute kidney injury is unknown. The goal of this study was to measure FGF-23 levels in critically ill patients with acute kidney injury to determine whether FGF-23 levels were elevated, as in chronic kidney disease.
Plasma FGF-23 and intact parathyroid hormone (PTH) levels were measured in 12 patients with acute kidney injury and 8 control subjects.
FGF-23 levels were significantly higher in acute kidney injury cases than in critically ill subjects without acute kidney injury, with a median FGF-23 level of 1948 RU/mL (interquartile range (IQR), 437-4369) in cases compared with 252 RU/mL (IQR, 65-533) in controls (p = 0.01). No correlations were observed between FGF-23 and severity of acute kidney injury (defined by the Acute Kidney Injury Network criteria); among patients with acute kidney injury, FGF-23 levels were higher in nonsurvivors than survivors (median levels of 4446 RU/mL (IQR, 3455-5443) versus 544 RU/mL (IQR, 390-1948; p = 0.02). Severe hyperparathyroidism (defined as intact PTH >250 mg/dL) was present in 3 of 12 (25%) of the acute kidney injury subjects versus none of the subjects without acute kidney injury, although this result did not meet statistical significance.
We provide novel data that demonstrate that FGF-23 levels are elevated in acute kidney injury, suggesting that FGF-23 dysregulation occurs in acute kidney injury as well as chronic kidney disease. Further studies are needed to define the short- and long-term clinical effects of dysregulated mineral metabolism in acute kidney injury patients.
成纤维细胞生长因子 23（FGF-23）是一种新型的矿物质代谢调节剂，在慢性肾脏病中显著升高，并与不良的长期预后相关。然而，FGF-23 在急性肾损伤中是否具有类似的作用尚不清楚。本研究的目的是测量急性肾损伤危重症患者的 FGF-23 水平，以确定 FGF-23 水平是否像在慢性肾脏病中那样升高。
测量了 12 例急性肾损伤患者和 8 例对照者的血浆 FGF-23 和完整甲状旁腺激素（PTH）水平。
急性肾损伤患者的 FGF-23 水平明显高于无急性肾损伤的危重症患者，中位数 FGF-23 水平为 1948 RU/mL（四分位距（IQR），437-4369），而对照组为 252 RU/mL（IQR，65-533）（p=0.01）。FGF-23 与急性肾损伤的严重程度（根据急性肾损伤网络标准定义）之间无相关性；在急性肾损伤患者中，非幸存者的 FGF-23 水平高于幸存者（中位数水平分别为 4446 RU/mL（IQR，3455-5443）与 544 RU/mL（IQR，390-1948）；p=0.02）。12 例急性肾损伤患者中有 3 例（25%）存在严重甲状旁腺功能亢进（定义为完整 PTH＞250 mg/dL），而无急性肾损伤患者无一例存在，尽管这一结果未达到统计学意义。
我们提供了新的数据，表明 FGF-23 水平在急性肾损伤中升高，提示 FGF-23 失调发生在急性肾损伤和慢性肾脏病中。需要进一步研究来确定急性肾损伤患者矿物质代谢失调的短期和长期临床影响。
