{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:01:26Z","timestamp":1788930086352,"version":"build-2803163510"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"am","delay-in-days":365,"URL":"http:\/\/rsc.li\/journals-terms-of-use"}],"funder":[{"DOI":"10.13039\/501100001501","name":"University Grants Commission","doi-asserted-by":"publisher","award":["211610166334"],"award-info":[{"award-number":["211610166334"]}],"id":[{"id":"10.13039\/501100001501","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["rsc.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Understanding metabolic alterations in CKD is crucial, as serum creatinine-based diagnosis lacks precision, affecting key clinical decisions. In this study, a 1H NMR-based metabolomics approach was employed to distinguish between advanced-stage CKD (ASCKD) patients and healthy controls (HC), as well as within the ASCKD stages (stage 4 and stage 5). Serum samples from 52 ASCKD (S4, S5) and 25 HC were analyzed. Multivariate and univariate analysis revealed distinct metabolic patterns across groups, providing insights into CKD pathophysiology and associated pathway alterations. Compared to HC, six metabolites were significantly altered in both stage 4 and 5 CKD patients with upregulated creatinine, urea, myoinositol, choline, N,N-dimethylglycine, and downregulated tyrosine, showing potential as biomarkers with AUC above 0.8 in ROC analysis. Additionally, myo-inositol, dimethylamine, N,N-dimethylglycine, and choline correlate positively with creatinine while tyrosine correlates negatively. Amino acid metabolism was downregulated in S5 indicating more severity. Within ASCKD patients, significant alterations were observed in metabolites such as glutamate, glutamine, alanine, threonine, myo-inositol, dimethylamine, citrulline, urea, citrate, and betaine. Pathway analysis identified five distinct metabolic pathways associated with CKD progression. Consequently, we propose a panel of serum metabolites which should be monitored along with creatinine for following CKD progression. Markers of oxidative stress, inflammation, and gut dysbiosis were evident in the perturbed metabolic profile due to the systemic impact of CKD.<\/jats:p>\n                  <jats:p\/>","DOI":"10.1039\/d5mo00019j","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T08:01:03Z","timestamp":1750060863000},"page":"464-478","update-policy":"https:\/\/doi.org\/10.1039\/rsc_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Understanding metabolic alterations in advanced stage chronic kidney disease patients by NMR-based metabolomics"],"prefix":"10.1093","volume":"21","author":[{"given":"Amrita","family":"Sahu","sequence":"first","affiliation":[{"name":"Centre of Biomedical Research, Sanjay Gandhi Post Institute of Medical Sciences Campus a , Raebareli Road, Lucknow, Uttar Pradesh, 226014, India \u00a0 bikashbaishya@gmail.com \u00a0 baishyab@cbmr.res.in"},{"name":"Academy of Scientific and Innovative Research (AcSIR) b , Ghaziabad 201002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upasna","family":"Gupta","sequence":"additional","affiliation":[{"name":"Centre of Biomedical Research, Sanjay Gandhi Post Institute of Medical Sciences Campus a , Raebareli Road, Lucknow, Uttar Pradesh, 226014, India \u00a0 bikashbaishya@gmail.com \u00a0 baishyab@cbmr.res.in"},{"name":"Academy of Scientific and Innovative Research (AcSIR) b , Ghaziabad 201002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4669-6600","authenticated-orcid":false,"given":"Bikash","family":"Baishya","sequence":"additional","affiliation":[{"name":"Centre of Biomedical Research, Sanjay Gandhi Post Institute of Medical Sciences Campus a , Raebareli Road, Lucknow, Uttar Pradesh, 226014, India \u00a0 bikashbaishya@gmail.com \u00a0 baishyab@cbmr.res.in"},{"name":"Academy of Scientific and Innovative Research (AcSIR) b , Ghaziabad 201002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dharmendra Singh","family":"Bhadauria","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences c , Lucknow, Uttar Pradesh, 226014, India \u00a0 docdharm10@gmail.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3235-6127","authenticated-orcid":false,"given":"Neeraj","family":"Sinha","sequence":"additional","affiliation":[{"name":"Centre of Biomedical Research, Sanjay Gandhi Post Institute of Medical Sciences Campus a , Raebareli Road, Lucknow, Uttar Pradesh, 226014, India \u00a0 bikashbaishya@gmail.com \u00a0 baishyab@cbmr.res.in"},{"name":"Academy of Scientific and Innovative Research (AcSIR) b , Ghaziabad 201002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"issue":"3","key":"2026012914045931000_cit1","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1038\/ki.2013.243","article-title":"Comments on \u2018KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease\u2019","volume":"84","author":"Andrassy","year":"2013","journal-title":"Kidney Int."},{"key":"2026012914045931000_cit2","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1007\/s10157-012-0704-5","article-title":"Performance of GFR equations in Japanese subjects","volume":"17","author":"Horio","year":"2013","journal-title":"Clin. 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