Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes

Tianye Yang, Wenji Wang, Xiao Tang, Peng Shi, Lulu Zhang, Wenyan Yu, Yingxin Xie, Daqiao Guo, Feng Ding, Tianye Yang, Wenji Wang, Xiao Tang, Peng Shi, Lulu Zhang, Wenyan Yu, Yingxin Xie, Daqiao Guo, Feng Ding

Abstract

Background: Numerous studies have evaluated the prevalence and importance of mineral and bone disorders among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, little is known about dysregulated mineral and bone metabolism in acute kidney injury (AKI).

Methods: We evaluated the association between mineral and bone metabolites and clinical outcomes in 158 patients who underwent cardiac surgery and developed AKI between June 2014 and January 2016. The baseline characteristics of the patients were recorded, and the levels of mineral and bone metabolites, including calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25D), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b) and C-terminal fibroblast growth factor 23 (cFGF23) were measured within 12 h after establishing the clinical diagnosis.

Results: The serum phosphate, iPTH and cFGF23 levels were significantly associated with the 28-day mortality (phosphate: Hazard Ratio [HR] =2.620, 95% CI: 1.083 to 6.338, p = 0.035; iPTH: HR = 1.044, 95% CI: 1.001 to 1.090, p = 0.046; cFGF23: HR = 1.367, 95% CI: 1.168 to 1.599, p < 0.001). Moreover, higher serum cFGF23 and BAP levels were independently associated with an increased risk of adverse outcomes. Additionally, we found that the serum cFGF23 levels rose most significantly and were associated with the severity of AKI (P < 0.001).

Conclusions: Mineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI.

Trial registration: www.clinicaltrials.gov NCT00953992. Registered 6 August 2009.

Keywords: Acute kidney injury; Adverse outcomes; Cardiac surgery; Mineral and bone disorder.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mineral and bone metabolite levels in a subgroup of 71 patients with different stages of AKI. The (a) Scr levels, (b) calcium levels, (c) phosphate levels, (d) iPTH levels, (e) 25D levels, (f) BAP levels, (g) TRACP-5b levels, and (h) cFGF23 levels. --●-- (dot): AKI stage 1 (n = 23); −-▇--(square): AKI stage 2 (n = 24); ▲ (triangle): AKI stage 3 (n = 24). P values are from repeated-measures linear mixed models comparing the 3 groups. *P < 0.05, **P < 0.01, and ***P < 0.001; a comparison of the biomarker levels cross AKI categories at individual time points. The data are shown as the median (interquartile range). Scr: serum creatinine; iPTH: intact parathyroid hormone; 25D: 25-hydroxyvitamin D; BAP: bone-specific alkaline phosphatase; TRACP-5b: tartrate-resistant acid phosphatase 5b; cFGF23: C-terminal fibroblast growth factor 23

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