Association between mineral and bone disorder in patients with acute kidney injury following cardiac surgery and adverse outcomes

BMC Nephrol. 2019 Oct 15;20(1):369. doi: 10.1186/s12882-019-1572-y.


Background: Numerous studies have evaluated the prevalence and importance of mineral and bone disorders among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, little is known about dysregulated mineral and bone metabolism in acute kidney injury (AKI).

Methods: We evaluated the association between mineral and bone metabolites and clinical outcomes in 158 patients who underwent cardiac surgery and developed AKI between June 2014 and January 2016. The baseline characteristics of the patients were recorded, and the levels of mineral and bone metabolites, including calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25D), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b) and C-terminal fibroblast growth factor 23 (cFGF23) were measured within 12 h after establishing the clinical diagnosis.

Results: The serum phosphate, iPTH and cFGF23 levels were significantly associated with the 28-day mortality (phosphate: Hazard Ratio [HR] =2.620, 95% CI: 1.083 to 6.338, p = 0.035; iPTH: HR = 1.044, 95% CI: 1.001 to 1.090, p = 0.046; cFGF23: HR = 1.367, 95% CI: 1.168 to 1.599, p < 0.001). Moreover, higher serum cFGF23 and BAP levels were independently associated with an increased risk of adverse outcomes. Additionally, we found that the serum cFGF23 levels rose most significantly and were associated with the severity of AKI (P < 0.001).

Conclusions: Mineral and bone metabolites are dysregulated and are associated with adverse clinical outcomes among patients with AKI.

Trial registration: NCT00953992. Registered 6 August 2009.

Keywords: Acute kidney injury; Adverse outcomes; Cardiac surgery; Mineral and bone disorder.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology
  • Aged
  • Bone Diseases / blood*
  • Bone Diseases / diagnosis
  • Bone Diseases / etiology
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / trends
  • Cohort Studies
  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / blood*
  • Humans
  • Male
  • Middle Aged
  • Minerals / blood
  • Parathyroid Hormone / blood*
  • Phosphates / blood
  • Postoperative Complications / blood*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Prospective Studies
  • Treatment Outcome


  • Minerals
  • Parathyroid Hormone
  • Phosphates
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23

Associated data