Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery

Sreekanth R Cheruku; Javier A Neyra; Hamza Mohammad; Johnny Trinh; Georgina Hernandez; Paul A Nakonezny; Michael E Jessen; Orson W Moe; Amanda A Fox

doi:10.1097/ALN.0000000000005605

Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery

Anesthesiology. 2025 Jun 9. doi: 10.1097/ALN.0000000000005605. Online ahead of print.

Authors

Sreekanth R Cheruku¹, Javier A Neyra^{2

3}, Hamza Mohammad¹, Johnny Trinh¹, Georgina Hernandez¹, Paul A Nakonezny⁴, Michael E Jessen⁵, Orson W Moe^{3

6

7}, Amanda A Fox^{1

8}

Affiliations

¹ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center.
² Division of Nephrology, Department of Medicine, University of Alabama at Birmingham.
³ Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center.
⁴ Department of Biostatistics, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center.
⁵ Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center.
⁶ Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center.
⁷ Department of Physiology, University of Texas Southwestern Medical Center.
⁸ McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center.

PMID: 40489631
DOI: 10.1097/ALN.0000000000005605

Abstract

Background: Acute kidney injury (AKI) occurs in 20-30% of cardiac surgery patients and is most often classified as mild. A prior study reported that intact fibroblast growth factor 23 (iFGF23) and C-terminal fibroblast growth factor 23 (cFGF23) measured after cardiopulmonary bypass (CPB) were associated with severe AKI after cardiac surgery, but did not analyze the association between iFGF23 and all-stage AKI. The primary aim of our study was to determine whether FGF23 biomarker measurements six hours following CPB were associated with all-stage AKI after cardiac surgery.

Methods: This prospective observational study included 173 patients undergoing non-emergent coronary artery bypass graft (CABG) and/or valve surgery on CPB. The primary study outcome was all-stage postoperative in-hospital AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria through postoperative day seven or earlier if hospital stay was less than 7 days. Plasma iFGF23 and cFGF23 were measured six hours after the end of CPB.

Results: A total of 32 patients developed in-hospital postoperative AKI (18.5%) by the seventh post-operative day. The incidence of AKI was 18.5% in CABG patients, 14.3% in valve surgery patients, and 41.2% in combined CABG-valve patients. A 2-fold increase in cFGF23 was associated with 1.57 greater predicted odds of developing in-hospital postoperative AKI (OR 1.57; 95% CI: 1.26 - 1.96; p<0.0001). This association remained significant after adjusting for clinical covariates (OR 1.40; 95% CI: 1.10 - 1.77; p=0.006) and after adjusting for preoperative Cleveland Clinic Score (OR 1.54; 95% CI: 1.22 - 1.95; p=0.0003). A 2-fold increase in iFGF23 was associated with 1.59 greater predicted odds of developing in-hospital postoperative AKI (OR 1.59; 95% CI: 1.08 - 2.35; p=0.018).

Conclusions: Early postoperative measurements of cFGF23 and iFGF23 are associated with all-stage AKI after cardiac surgery. The utility of these biomarkers for risk-classification in cardiac surgery patients remains to be determined.