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Bone Abstracts (2014) 3 PP74 | DOI: 10.1530/boneabs.3.PP74

Bone development/growth and fracture repair

Bone turnover and FGF-23 levels in vitamin D-deficient critically ill patients with and without acute kidney injury

Christian Schnedl1, Egbert Bisping2, Paul Zajic1, Hans Peter Dimai1, Doris Wagner3, Thomas R Pieber1, Astrid Fahrleitner-Pammer1 & Karin Amrein1


1Division of Endocrinology and Metabolism, Medical University, Graz, Austria; 2Division of Cardiology, Medical University, Graz, Austria; 3Department of Surgery, Medical University, Graz, Austria.

Introduction: Elevated FGF-23 serum levels are induced by hyperphosphatemia and are linked to poor skeletal mineralization and adverse outcomes including vascular calcification and mortality. Recently, it was shown that FGF-23 levels are substantially elevated in acute kidney injury (AKI), and that higher levels in AKI are associated with a greater risk of adverse outcomes.

Methods: In 25 vitamin D deficient (25(OH)D <20 ng/ml) critically ill adults with and without AKI, markers of bone and mineral metabolism (25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, ionized and total serum calcium, phosphorus, bone specific alkaline phosphatase, osteocalcin, tartrate resistant acid phosphatase, β-crosslaps) were measured. FGF-23 was measured using a C-terminal FGF-23 ELISA (Immutopics, San Clemente).

Results: The mean age was 63±16 years and 76% were men. FGF-23 levels were significantly higher in patients with AKI (median 2720 RU/ml, range 351–8708) compared to patients without AKI (150 RU/ml, 55–14 000; P<0.001) and nonsignificantly higher in nonsurvivors (n=12, 624 RU/ml, 61–8709) compared to survivors (312 RU/ml, 55–14 000, P=0.453). There was no significant correlation between FGF-23 and any of the measured biochemical markers.

Discussion: In our small cohort of medical critically ill patients, FGF-23 levels were substantially higher than in other reported populations. In patients with AKI these were significantly higher than in patients without AKI. There was no significant correlation of FGF-23 and any of the determined markers of bone and mineral metabolism, although this may primarily be a matter of small sample size, as the correlation coefficient was strongest for serum phosphorus, ionized calcium and osteocalcin and reached values of almost 0.3. In conclusion, the role of FGF-23 in critical illness remains unclear and further studies on this topic are warranted.

Volume 3

European Calcified Tissue Society Congress 2014

Prague, Czech Republic
17 May 2014 - 20 May 2014

European Calcified Tissue Society 

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