If a direct role is present, the downstream consequences of FGF23 in critically-ill patients leading to AKI are largely unknown; however, elevated plasma FGF23 levels have been implicated in the pathogenesis of endothelial dysfunction [22–24], immunosuppression [25] and inflammation [26] in CKD patients, making these effects possible FGF23 pathways in AKI. This evidence concerns the gene FGF23 and acute kidney injury.