Kidney Week

Abstract: TH-PO0727

The Effluent Proteome in Patients with AKI Requiring CKRT

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Madison, David, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

David Madison

• He, Zhibin, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Zhibin He, MS

• Okamura, Kayo, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Kayo Okamura

• Ozekin, Yunus, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Yunus Ozekin, PhD

• Colbert, James, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

James Colbert, MD

• Faubel, Sarah, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States

Sarah Faubel, MD

Background

Critically ill patients with AKI requiring CKRT have a 50% mortality rate. Solute clearance during CKRT is indiscriminate. No prior studies have systematically characterized the quantity and classes of proteins that are removed, including proteins that may be beneficial such as antimicrobial peptides (AMPs). AMPs are small polypeptides approximately 10 to 15 kDa in size which are key components of the innate immune system and kill pathogens via multiple mechanisms.

Methods

Effluent samples from 6 critically ill patients with AKI were collected within 12 hours of CKRT initiation. Proteome profiling was performed via liquid chromatography-mass spectrometry. Over-representation analysis was performed using the Reactome bioinformatics toolset. The effluent proteome was interrogated against the human AMP database to determine the number and identity of AMPs present.

Results

A total of 1,258 proteins were identified in the effluent samples. Over-representation analysis showed significant representation of several critical pathways, including the immune system, hemostasis, and metabolism as shown in Table 1. 89 of the ~ 150 human AMPs were identified in the effluent. Well known AMPs that were present in the effluent included hepcidin, β2 microglobulin, and lysozyme.

Conclusion

A broad array of proteins are removed during CKRT, many of which may be important for recovery from critical illness. Iatrogenic removal of AMPs may be particularly impactful as sepsis is a leading cause of mortality in patients with AKI requiring CKRT. Future studies to investigate whether removal of beneficial proteins including AMPs may contribute to the high mortality rate in patients with AKI requiring CKRT are warranted.

Table 1. Pathway analysis of effluent proteins. Proteome data were analyzed to determine the most significantly represented pathways. A probability score (pValue) was corrected for false discovery rate (FDR) using the Benjamini-Hochberg method.

Funding

• Private Foundation Support