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. 2022 Mar;26(3):302-306.
doi: 10.5005/jp-journals-10071-24124.

Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study

Narinder Pal Singh  1 , Vikrant Panwar  2 , Neeru P Aggarwal  3 , Satish K Chhabra  4 , Anish K Gupta  1 , Anirban Ganguli  5
Affiliations

Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study

Narinder Pal Singh et al. Indian J Crit Care Med. 2022 Mar.

Abstract

Background: Maintaining homeostasis is an integral part of all physiological processes both in health and disease including critically ill patients and may impact clinical outcomes. The present study was designed to assess prevalence of serum calcium, phosphate, vitamin-D3, FGF-23, and PTH levels abnormalities in AKI.

Patients and methods: Single-center, prospective, observational study in a tertiary care hospital. Patients meeting KDIGO criteria for AKI were included. Paired blood samples were drawn from eligible patients-first sample within 24 hours of AKI diagnosis and second after 5 days or at time of hospital discharge, whichever was earlier for measuring serum calcium (albumin corrected), phosphate, PTH, 25(OH)Vit-D, and FGF-23 levels. Clinical outcomes analyzed included survival status, utilization of RRT, and hospital stay.

Results: Of the 50 patients with AKI, about three-fourths were males. Mean age of the participants was 57.32 ± 11.47 years. Around half of patients had hypocalcemia and four-fifths had low serum phosphate. Nearly 82% had low 25(OH)Vit-D and 52% cases had high PTH level. Patients who underwent RRT had numerically higher but not significant serum calcium and PTH levels. FGF-23 levels (pg/mL) were significantly higher in patients on RRT (81.70 ± 17.30 vs non-RRT, 72.43 ± 20.27, p = 0.049), nonsurvivors (87.96 ± 18.82 vs survivors 57.11 ± 15.19, p = 0.045), and those hospitalized for time of stay above median (109.67 ± 26.97 vs below median 70.27 ± 20.43, p = 0.046). Among all the bone and mineral parameters analyzed high FGF23 levels were consistently linked with poor clinical outcomes in AKI.

Conclusion: The present study found high prevalence of calcium and phosphate disorders in AKI with dysregulated phosphate homeostasis as evidenced from elevated FGF-23 levels linked with morbidity and mortality in AKI.

How to cite this article: Singh NP, Panwar V, Aggarwal NP, Chhabra SK, Gupta AK, Ganguli A. Regulation of Calcium Homeostasis in Acute Kidney Injury: A Prospective Observational Study. Indian J Crit Care Med 2022;26(3):302-306.

Keywords: Acute kidney injury; Calcium homeostasis; Fibroblast growth factor-23; Parathyroid hormone; Vitamin D.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Prevalence of comorbidities in study population
Fig. 2
Fig. 2
AKI risk factors in study population
Fig. 3
Fig. 3
Mineral and bone disease abnormalities in study population
See this image and copyright information in PMC

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