Advances in uremic toxin detection and monitoring in the management of chronic kidney disease progression to end-stage renal disease

Patients with end-stage kidney disease (ESKD) rely on dialysis to remove toxins and stay alive. However, hemodialysis alone is insufficient to completely remove all/major uremic toxins, resulting in the accumulation of specific toxins over time. The complexity of uremic toxins and their varying clea...

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Bibliographic Details
Published in:Analyst (London) 2024-05, Vol.149 (1), p.2784-2795
Main Authors: Lee, Han, Liu, Kuan-Hung, Yang, Yu-Hsuan, Liao, Jiunn-Der, Lin, Bo-shen, Wu, Zheng-Zhe, Chang, Alice Chinghsuan, Tseng, Chin-Chung, Wang, Ming-Cheng, Tsai, Yau-Sheng
Format: Article
Language:English
Subjects:
Biomarkers
Biomarkers - analysis
Biomarkers - blood
Disease Progression
Free surfaces
Hemodialysis
Humans
Kidney diseases
Kidney Failure, Chronic - therapy
Labels
Microfluidics
Pathogenesis
Qualitative analysis
Raman spectroscopy
Renal Dialysis
Renal Insufficiency, Chronic - diagnosis
Renal Insufficiency, Chronic - therapy
Spectrum Analysis, Raman - methods
Toxins
Uremic Toxins - analysis
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Summary:Patients with end-stage kidney disease (ESKD) rely on dialysis to remove toxins and stay alive. However, hemodialysis alone is insufficient to completely remove all/major uremic toxins, resulting in the accumulation of specific toxins over time. The complexity of uremic toxins and their varying clearance rates across different dialysis modalities poses significant challenges, and innovative approaches such as microfluidics, biomarker discovery, and point-of-care testing are being investigated. This review explores recent advances in the qualitative and quantitative analysis of uremic toxins and highlights the use of innovative methods, particularly label-mediated and label-free surface-enhanced Raman spectroscopy, primarily for qualitative detection. The ability to analyze uremic toxins can optimize hemodialysis settings for more efficient toxin removal. Integration of multiple omics disciplines will also help identify biomarkers and understand the pathogenesis of ESKD, provide deeper understanding of uremic toxin profiling, and offer insights for improving hemodialysis programs. This review also highlights the importance of early detection and improved understanding of chronic kidney disease to improve patient outcomes. Patients with end-stage kidney disease (ESKD) rely on dialysis to remove toxins and stay alive.
ISSN:0003-2654
1364-5528
DOI:10.1039/d4an00057a