Abstract: FR-PO119

Pre-Operative Level of Fibroblast Growth Factor 23 Is Associated with the Risk of Developing Severe AKI after Heart Surgery

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational


  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Volovelsky, Oded, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Fibroblast growth factor 23 (FGF23) has been assessed as an early AKI biomarker after renal ischemia in animals and humans. FGF23 is an early marker of chronic kidney disease in humans. We assessed the ability of pre-operative FGF23 to predict severe AKI after cardiac surgery in children.


Blood and urine samples were collected in a prospective observational study from 83 children with congenital heart disease. Serum creatinine, cystatin C, FGF23 and urine levels of NGAL, IL18, KIM-1, L-FABP were assessed pre-operatively. Severe AKI (sAKI; KDIGO stages II-III) was the primary outcome. Non-parametric multivariable linear regression and ROC analyses were used to evaluate the association between pre-operative FGF23, urine markers and the development of sAKI in the first week after CS.


Median age [IQR] was 7 (2.2, 61) months and median bypass time was 135 [89,205] minutes. Surgical severity level, Cystatin C and urinary biomarkers did not differ between pts with vs. without sAKI. Pre-operative FGF23 was higher in pts who developed sAKI (Table) The AUC-ROC for preoperative FGF23 level to predict sAKI was 0.75 (0.56-0.95). Logistic regression of FGF23 had superior odd ratio for severe AKI (4.96).


Pre-operative FGF23 levels were associated with developing sAKI after CS. Current biomarker strategies focus on early postoperative diagnosis and treatment of AKI. Preoperative identification of children with higher risk of AKI after CS may help in developing AKI prevention strategies and risk stratification scores.

Preoperative parametersSevere AKIWithout severe AKIp-value
Age (days)0.40.34,, 2.30.08
RACHS score32, 422, 30.09
FGF23 level572275, 1294498226, 9280.0008
Cyctatin C GFR88.566.5, 1269667, 1220.81
NGAL3.062.7, 29.23.482, 6.90.60
IL1897.7616.61, 108.228.6 12.7, 63.20.27
KIM1273194, 390534239, 8310.08
LFABP2.50.7,, 40.89

IQR = Interquartile range