Hemodialysis.com: Author Interview:David Leaf, M.D.
Nephrology Fellow
Brigham and Women's Hospital/Massachusetts General Hospital
FGF-23 Levels in Patients with AKI and Risk of Adverse Outcomes
David E. Leaf, Myles Wolf, Sushrut S. Waikar, Herbert Chase,
Marta Christov, Serge Cremers, and Leonard Stern
FGF-23 Levels in Patients with AKI and Risk of Adverse Outcomes CJASN CJN.00550112; published ahead of print June 14, 2012, doi:10.2215/CJN.00550112
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Hemodialysis.com: What are the main findings of the study?
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Among patients with acute kidney injury (AKI), serum levels of fibroblast growth factor 23 (FGF-23), a potent phosphaturic hormone released by osteocytes, are elevated and associated with greater risk of death or need for renal replacement therapy.
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Hemodialysis.com: Were any of the findings unexpected?
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Elevated levels of FGF23 per se were not unexpected, as this was the central hypothesis of the study. However, the degree of elevation of FGF-23 among patients with AKI was dramatic and somewhat unexpected.
Furthermore, although FGF-23 levels were significantly lower among control participants (hospitalized patients without AKI) compared to with those participants with AKI, controls had much higher FGF-23 levels than those previously reported in healthy, ambulatory volunteers.
This finding was also unexpected and may reflect a potential role for FGF-23 as an acute-phase reactant.
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Hemodialysis.com: What should clinicians and patients take away from this study?
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FGF-23 may be an important biomarker among patients with AKI.
Whether elevated FGF-23 levels may be directly toxic to nontraditional target organs, such as the cardiovascular, skeletal, and endocrine systems, and thereby contribute directly to adverse outcomes in AKI, which it seems to do in CKD, is an intriguing possibility that will require additional study.
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Hemodialysis.com:What recommendations do you have for future studies as a result of your study?
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Developing FGF-23 as a biomarker in AKI will require additional testing and validation in larger AKI cohorts and comparisons of FGF-23 with other more established biomarkers of AKI.
One specific area of interest is whether FGF-23 levels rise earlier than serum creatinine among patients with AKI, and therefore might serve as a useful diagnostic test to more rapidly identify patients at risk.
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