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Licensed Unlicensed Requires Authentication Published by De Gruyter April 22, 2021

Urinary exosomal CD26 is associated with recovery from acute kidney injury in intensive care units: a prospective cohort study

Juan Du , Yihui Li , Qiang Sun , Zhihao Wang , Feng Wang , Fangfang Chen , Hao Wang , Yirui Liu , Huimin Zhou , Guokai Shang , Xiaomei Chen , Shifang Ding , Chen Li , Dawei Wu , Wei Zhang and Ming Zhong EMAIL logo



Currently there is no validated method to predict renal reversal and recovery after acute kidney injury (AKI). As exosomes have the potential for AKI prognosis and CD26 is involved in the mechanisms in AKI, this study aims to investigate whether urinary exosomal CD26 is associated with renal-related outcomes and explore its prospect as a novel prognosis biomarker.


This was a single-center, prospective cohort study. A total of 133 AKI patients and 68 non-AKI patients admitted to ICU in Qilu Hospital Shandong University from January 2017 to January 2018. Urine samples were collected at enrollment and the relative expression of CD26 (CD26 percentage) in urinary exosomes was examined, that was then categorized into a low-CD26 level and a high-CD26 level.


CD26 percentage was significantly lower in the AKI cohort than in the control cohort. Within the AKI cohort, a high-CD26 level was associated with lower incidence of major adverse kidney events within 90 days, but higher incidence of reversal within 28 days. In AKI survivors, a high-CD26 level had a 4.67-, 3.50- and 4.66-fold higher odds than a low-CD26 level for early reversal, recovery and reversal, respectively, after adjustment for clinical factors. Prediction performance was moderate for AKI survivors but improved for non-septic AKI survivors.


Urinary exosomal CD26 is associated with renal reversal and recovery from AKI and is thus a promising prognosis biomarker.

Corresponding author: Ming Zhong, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wen Hua Xi Road, 250012, Jinan, Shandong, P.R. China, Phone: +86 531 82169339, Fax: +86 531 86169356, E-mail:

Award Identifier / Grant number: 81470560

Award Identifier / Grant number: 81873534

Award Identifier / Grant number: 81570400

Award Identifier / Grant number: 81801953

Award Identifier / Grant number: 81670411

Award Identifier / Grant number: 81471036

Award Identifier / Grant number: 81600633

Award Identifier / Grant number: 81702194

Funding source: Key Research and Development Program of Shandong Province

Award Identifier / Grant number: 2019GSF108041

Award Identifier / Grant number: 2018GSF118002

Award Identifier / Grant number: 2017GSF18156

Award Identifier / Grant number: ZR2019BH064


We give special thanks to my friend Luying Hou for her endeavor in improving the writing of this paper.

  1. Research funding: Ming Zhong received funding from the National Natural Science Foundation of China (81470560) and 10 Key Research and Development Program of Shandong Province (2019GSF108041). Wei Zhang received 11 funding from the National Natural Science Foundation of China (81873534 and 81570400) and from the 12 Key Research and Development Program of Shandong Province (2018GSF118002). Yihui Li received 13 funding from the National Natural Science Foundation of China (81801953 and 81670411) and the 14 Natural Science Foundation of Shandong Province (ZR2019BH064). Zhihao Wang received funding 15 from the National Natural Science Foundation of China (81471036 and 81600633) and Key Research 16 and Development Program of Shandong Province (2017GSF18156). Guokai Shang received funding 17 from the National Natural Science Foundation of China (81702194).

  2. Author contributions: J.D. and M.Z. designed and performed the experiments; collected, analyzed and interpreted the data; and wrote the manuscript. Y.L. designed and performed the experiments and analyzed and interpreted the data. F.W., F.C., H.Z. and G.S. performed the experiments. Q.S., H.W., Y.L., C.L. and S.D. collected, analyzed and interpreted the data. Z.W., D.W., X.C. and W.Z. helped to design and write the manuscript. All authors read and approved the final manuscript.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study protocol was approved by the Ethics Committee of Qilu Hospital, Shandong University (IERB: 2017074).


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2021-01-10
Accepted: 2021-03-30
Published Online: 2021-04-22
Published in Print: 2021-08-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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