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

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

doi:10.1186/s12882-019-1572-y

Abstract

BackgroundNumerous 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).MethodsWe 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.ResultsThe 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).ConclusionsMineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI.Trial registrationwww.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.

Highlights

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)
acute kidney injury (AKI) was defined as an increase in serum creatinine of ≥0.3 mg/ dL within 48 h or that of ≥50% within 7 days, which conforme with the criteria established by the Kidney Disease Improving Global Outcomes (KDIGO) work group [17]
We evaluated whether the phosphate, intact parathyroid hormone (iPTH), and C-terminal fibroblast growth factor 23 (cFGF23) levels remained associated with 28-day mortality after the adjustment for each

Summary

Introduction

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). Acute kidney injury (AKI) is a common problem in seriously ill patients and is associated with several poor clinical outcomes [1,2,3,4,5,6]. Numerous studies have proven that chronic kidney disease-mineral and bone disorder (CKD-MBD) is associated with adverse clinical outcomes [7,8,9]. Little is known about mineral and bone disorder and its association with outcomes among patients with AKI. The role of markers of bone metabolism in the prediction of mortality in patients with CKD has been prospectively evaluated. Markers of bone formation (bone-specific alkaline phosphatase [BAP]) and bone resorption (tartrate-resistant acid phosphatase 5b [TRACP5b]) can serve as predictors of cardiovascular morbidity and mortality in patients with CKD [16]

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Results

Conclusion