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Abstract: FR-PO1118

Circulating FGF23 Is Associated with AKI and Predicts Survival in COVID-19

Session Information

  • COVID-19 - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Burney, Heather, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Arroyo, Eliott, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Halim, Arvin, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Li, Yang, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Li, Xiaochun, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Sher, Syed Jawad, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

20-40% of severely ill COVID-19 patients develop acute kidney injury (AKI). AKI is now considered to be a negative prognostic factor for survival in COVID-19 patients. FGF23 is a bone-derived phosphatonin that is elevated in AKI. To-date, no study has investigated the associations between FGF23 and AKI in the COVID-19 population. Herein, we performed a study evaluating FGF23 levels in a cohort of COVID-19 patients and its association with AKI status and survival.

Methods

We conducted a prospective cohort study in 111 patients hospitalized with COVID-19. Total FGF23 levels were measured using an ELISA assay (Quidel). AKI status and FGF23 levels were determined concurrently. The primary outcome was death and secondary endpoint was AKI status. The median follow-up to death was 22.6 months. Associations between FGF23 levels and AKI status and survival were assessed by logistic regression and cox proportional hazards models, respectively.

Results

Of the 111 patients, 77 had no AKI (eGFR=91.0 [69.2,101.3] ml/min/1.73m2), 17 had AKI (eGFR=39.7 [28.7,57.8] ml/min/1.73m2), and 17 had end-stage kidney disease (ESKD, p<0.001). Patients did not significantly differ in sex (p=0.6) or age (p=0.9) but differed in BMI (p=0.023). Median FGF23 levels were higher in patients with AKI (305.6 [134.6, 350.8] RU/mL) and ESKD (3,607.7 [440.5, 7,452.7] RU/mL) compared to those with no AKI (120.7 [64.3, 249.7] RU/mL]; p<0.001). After adjusting for patient age, patients with high FGF23 showed increased odds of having AKI (p=0.004). Survival at 24 months was higher among non-AKI patients (71%) compared to AKI (65%) and ESKD (35%) patients (p=0.02). Finally, controlling for patient age and group-specific death hazards among non-AKI, AKI and ESKD groups, FGF23 was significantly associated with an increased risk of death (p<0.001).

Conclusion

Elevated FGF23 levels are associated with AKI and were predictive of survival in a cohort of COVID-19 patients. These findings indicate that FGF-23 levels may help with risk stratification and management of AKI in patients with COVID-19.

Funding

  • Other NIH Support