Abstract: TH-PO0742
Metabolomic Stabilization After CKRT in Critically Ill Patients
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
- Griffin, Benjamin R., University of Iowa Health Care, Iowa City, Iowa, United States
- Okamura, Kayo, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- He, Zhibin, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Faubel, Sarah, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background
Continuous kidney replacement therapy (CKRT) is widely used in critically ill patients with acute kidney injury (AKI) and hemodynamic instability to control volume, correct electrolyte abnormalities, and remove solutes that accumulate when kidney function is impaired. However, little is known about the temporal impact on the metabolome after CKRT initiation. We aimed to characterize longitudinal metabolomic changes during CKRT and determine whether metabolomic profiles achieve a steady state over time.
Methods
In this prospective observational cohort study, plasma samples were collected from 76 adult ICU patients with AKI immediately before CKRT initiation and on days 1, 2, and 3 of therapy. Control samples were collected from 26 healthy adults without kidney disease. 139 metabolites were identified using untargeted analysis with high-performance liquid chromatography–mass spectrometry. Overall temporal changes during CKRT were evaluated using scaled and averaged metabolite values over time.
Results
CKRT patients were critically ill with a median SOFA score of 14 and 30-day mortality of 51%. Prior to CKRT initiation, marked metabolic heterogeneity was observed with metabolite levels ranging from 0.15- to 44-fold relative to controls. Fifty-seven metabolites (42%) were elevated more than twofold, while 22 (16%) were reduced to <0.8-fold of control levels. Following CKRT initiation, metabolite levels declined for the first 48 hours following CKRT initiation with minimal additional change thereafter, consistent with establishment of a new metabolomic steady state (Figure 1).
Conclusion
Metabolites in patients with AKI prior to CKRT were highly variable rather than uniformly elevated. CKRT was associated with rapid metabolomic alterations that largely stabilized within 48 hours, suggesting development of a new metabolomic steady state early in the treatment course. These findings may have implications for precision CKRT strategies in critically ill patients.
Figure 1. Composite metabolite chage during CKRT
Funding
- Veterans Affairs Support – Vantive