Kidney international
-
Kidney international · Apr 2016
EditorialProton pump inhibitors and chronic kidney disease: is it time to sound the alarm?
Proton pump inhibitors are widely used worldwide for the management of gastroesophageal reflux, but have been associated with the development of interstitial nephritis and acute kidney injury. A large observational study using data from the Atherosclerosis Risk in Communities cohort and the Geisinger Health System demonstrates an association between the use of proton pump inhibitors and chronic kidney disease. Although the study does not prove causality, the robustness of the findings in two cohorts suggests a need for further study and reevaluation of the safety of these agents for widespread, non-prescription use.
-
Kidney international · Apr 2016
Fibroblast growth factor 23 levels are elevated and associated with severe acute kidney injury and death following cardiac surgery.
Fibroblast growth factor 23 (FGF23) is elevated in chronic kidney disease and associated with increased mortality, but data on FGF23 in humans with acute kidney injury (AKI) are limited. Here we tested whether FGF23 levels rise early in the course of AKI following cardiac surgery and if higher postoperative FGF23 levels are independently associated with severe AKI and adverse outcomes. Plasma C-terminal FGF23 (cFGF23) levels were measured preoperatively, at the end of cardiopulmonary bypass, and on postoperative days 1 and 3 in 250 patients undergoing cardiac surgery. ⋯ The levels of intact FGF23 also increased in patients who developed severe AKI, but the magnitude was lower than cFGF23. In analyses adjusted for age, preoperative eGFR, and cardiopulmonary bypass time, higher cFGF23 levels at the end of cardiopulmonary bypass were significantly associated with greater risk of severe AKI and the need for renal replacement therapy or death. Thus, cFGF23 levels rise early in AKI following cardiac surgery and are independently associated with adverse postoperative outcomes.