FGF23 levels significantly increase in female hip fracture patients who develop postoperative acute kidney injury (AKI). A pilot study measured FGF23 and creatinine levels in 9 female patients with postoperative AKI and 7 control patients without AKI. FGF23 levels were 39 times higher in the AKI group compared to controls, rising much more rapidly than creatinine. The findings suggest FGF23 may be a novel, early biomarker for detecting AKI after hip fracture surgery in women.

1. FGF23 LEVELS RAISE SIGNIFICANTLY IN FEMALE HIP
FRACTURE PATIENTS WITH POSTOPERATIVE AKI
Sakan S, Bandic Pavlovic D, Basic-Jukic N, Kes P, Magas Vadlja J, Tonkovic D
Department of Anesthesiology and Intensive care, Jordanovac Clinical Department of Thoracic surgery,
Zagreb University Hospital Center,Jordanovac 104, Zagreb, Croatia
1.Goebel et al. J Orthop Res 2009;
27:1141-1146; Christov et al. Kidney
International 2013; 84:776-785.
Wang WJ et al. J Bone Miner Res
2104; 29.676-684
References
Postoperative AKI
-commom complication in hip fracture surgery
-female geneder independent predictor
-AKI incidence varies between 9% and 24%
- associated with higher postoperative
morbidity, mortality, longer hospital stay and
treatment costs
-FGF23 novel, early, renal biomarker of AKI
HYPOTHESIS
FGF23 is a novel, early renal biomarker of postoperative AKI
in female hip fracture patients
A pilot prospective cohort study during one month period
Inclusion criteria: female gender, trauma hip fracture
surgery, semi-scheduled surgery, age >18 years
Study included two groups:
1) AKI group N=9
- female subjects who developed AKI 24 h after operation
according to RIFLE/AKIN criteria
2) Control group N=7
- female subjects with normal renal function 24h after
operation
STUDY PROTOCOL
AKI group- plasma FGF23, serum creatinine, phosphate i
calcium measurements 24h after operation
Control group- plasma FGF23 and serum creatinine
measurement 24h after operation
Introduction1
Methods2
Results3
AKI group FGF 23 levels were 39 times higher than
control group (2352 vs 61 RU/ml). Hypocalcemia
(median (IQR) 1,9 (1,70-2,01) mmol/l) and
normophosphatemia (median (IQR) 0,89 (0,56-1,51)
mmol/l) were recorded in the AKI group. Serum
creatinine showed the same pattern of changes as
FGF23 but not such large increase ( 354 vs 67 μmol/l)
4
Conclusion
Female AKI group Control group
N 9 7
Age* 80 (75-82) 75 (68-79)
Baseline serum
creatinine
μmol/l*
78 (70-82) 99 (82-107)
0
200
400
600
800
AKI group Control
group
FGF23
FGF23
0
50
100
150
200
AKI
group
Control
group
Creatinine
Creatinine
Postoperative FGF23 levels showed
significantly high and rapid elevation in
AKI female hip fracture group.
Female AKI group Control group
Sepsis 1 0
Length of the
ICU stay (days)
6 (1,5-20) 2 (2-3)
Length of post
ICU stay (days)
9 (4-27) 10 (8-13)
Hospital
mortality
1 0
Postoperative
complications
1 0
Table 1
Figure 1
Figure 2 Figure 3
Table 2
0 1 2
3
Arterial hypertension
Diabetes mellitus
Cardiovascular
Pulmonary
N
N
*Median (IQR)
*Median (IQR)
39x 5.3x