Levels of FGF-23 increase early in the course of acute kidney injury (AKI) following cardiac surgery and are independently associated with severe AKI and adverse outcomes, say researchers. Among 250 patients undergoing cardiac surgery, those who developed AKI had significantly higher levels of plasma c-terminal FGF-23 at the end of cardiopulmonary bypass and on postoperative days 1 and 3. In those who developed severe AKI, the levels of intact FGF-23 also increased after surgery.