Significance of serum FGF-23 for risk assessment of contrast-associated acute kidney injury and clinical outcomes in patients undergoing coronary angiography.

Shao-Sung Huang,Shing-Jong Lin,Hsin-Bang Leu,Tao-Cheng Wu,Jaw-Wen Chen,Po-Hsun Huang,Emmanuel A Burdmann

doi:10.1371/journal.pone.0254835

Abstract

Fibroblast growth factor (FGF)-23 levels rise as kidney function declines. Whether elevated FGF-23 levels are associated with an increased risk for contrast-associated acute kidney injury (CA-AKI) and major adverse cardiovascular events (MACE) in patients undergoing coronary angiography remain uncertain. In total, 492 patients receiving coronary angiography were enrolled. Their serum FGF-23 levels were measured before administration of contrast media. The occurrence of CA-AKI was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from the baseline value within 48 h after the procedure. All patients were followed up for at least 1 year or until the occurrence of MACE including death, nonfatal myocardial infarction (MI), and ischemic stroke. Overall, CA-AKI occurred in 41 (8.3%) patients. During a median follow-up of 2.6 years, there were 24 deaths, 3 nonfatal MIs, and 7 ischemic strokes. Compared with those in the lowest FGF-23 tertile, individuals in the highest FGF-23 tertile had a significantly higher incidence of CA-AKI (P < 0.001) and lower incidence of MACE-free survival (P = 0.001). In multivariate regression analysis, higher FGF-23 level was found to be independently associated with a graded risk for CA-AKI (OR per doubling, 1.90; 95% CI 1.48-2.44) and MACE (HR per doubling, 1.25; 95% CI 1.02-1.52). Elevated FGF-23 levels were associated with an increased risk for CA-AKI and future MACE among patients undergoing coronary angiography. FGF-23 may play a role in early diagnosis of CA-AKI and predicting clinical outcomes after coronary angiography.

Highlights

Contrast-induced nephropathy, known as contrast-associated acute kidney injury (CA-AKI), remains a serious clinical problem associated with the use of iodinated contrast media in diagnostic imaging and interventional procedures [1, 2]
Higher Fibroblast growth factor-23 (FGF-23) level was found to be independently associated with a graded risk for CA-AKI (OR per doubling, 1.90; 95% CI 1.48–2.44) and major adverse cardiovascular events (MACE) (HR per doubling, 1.25; 95% CI 1.02–1.52)
Elevated Fibroblast growth factor (FGF)-23 levels were associated with an increased risk for CA-AKI and future MACE among patients undergoing coronary angiography

Summary

Introduction

Contrast-induced nephropathy, known as contrast-associated acute kidney injury (CA-AKI), remains a serious clinical problem associated with the use of iodinated contrast media in diagnostic imaging and interventional procedures [1, 2]. Several risk factors are associated with CA-AKI, including the pre-existence of renal dysfunction, hypotension, heart failure, diabetes mellitus, older age, anemia, and the amount and type of contrast media used [3,4,5]. FGF-23 levels rise as renal function declines, and higher levels are strongly associated with increased risks of cardiovascular disease (CVD), heart failure, and progression to end-stage renal disease (ESRD) [13, 14]. The association between FGF-23 levels and acute kidney injury (AKI) has been studied. Patients with AKI show elevated FGF-23 levels, which are associated with a greater risk of death or need for renal replacement therapy [16]. Whether elevated FGF-23 levels are associated with an increased risk for contrast-associated acute kidney injury (CA-AKI) and major adverse cardiovascular events (MACE) in patients undergoing coronary angiography remain uncertain.

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