In this study, the research team sought to uncover potential biomarkers for chronic kidney disease (CKD) progression by analyzing the metabolites in urine samples. These samples were collected from 789 CKD patients at the time of kidney biopsy, and from 147 healthy subjects. The study aimed to identify markers signaling a 30% decline in estimated glomerular filtration rate (eGFR), a doubling of serum creatinine levels, or the onset of end-stage kidney disease.

The researchers identified seven metabolites that showed a clear distinction between healthy individuals and those with stage 1 CKD, as well as a consistent change in pattern from healthy to advanced-stage CKD patients. These metabolites were betaine, choline, glucose, fumarate, and citrate. These metabolites remained significantly associated with the composite outcome even after adjusting for factors like age, sex, eGFR, the urine protein-creatinine ratio, and diabetes. When these metabolites were added to traditional biomarkers such as eGFR and proteinuria, they significantly enhanced the ability to predict the composite outcome.

These urinary metabolites not only differentiate healthy individuals from early-stage CKD patients, but also exhibit consistent pattern changes in advanced-stage CKD patients. The ability of these metabolites to predict CKD progression significantly improves when combined with traditional biomarkers. Therefore, these findings could enable early intervention, help monitor disease progression, and potentially guide therapeutic strategies, thereby enhancing the overall management of CKD.

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