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Rapid progression was defined as a 25% increase in serum creatinine concentration over 6\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Serum metabolite ratios of the serotonin pathway showed promising potential for predicting rapid CKD progression in cats: L-tryptophan\/5-hydroxytryptophan (area under curve [AUC]: 0.89; 95% CI: 0.78\u20131; p\u2009&amp;lt;\u20090.01; sensitivity: 85.7%; specificity: 78.8%) and serotonin\/5-hydroxyindole-3-acetic acid (AUC: 0.83; 95% CI: 0.64\u20131; p\u2009&amp;lt;\u20090.01; sensitivity: 87.5%; specificity: 76.5%). Cats with rapidly progressive CKD had significantly lower baseline urinary indoxyl-sulfate (median [Interquartile range, IQR], 0.25 [0.07\u20130.46] vs. 0.53 [0.36\u20130.81]; p\u2009=\u20090.04) and p-cresyl-sulfate (median [IQR], 0.13 [0.01\u20130.79] vs. 0.83 [0.32\u20131.27]; p\u2009=\u20090.04). Logistic regression analysis identified an association between decreased urinary indoxyl-sulfate (odds ratio [OR]: 0.03; 95% CI: 0\u20131; p\u2009=\u20090.04) and rapidly progressive CKD, following a similar pattern after correcting for serum creatinine concentration (p\u2009=\u20090.06).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Metabolites of the serotonin pathway: L-tryptophan, 5-hydroxytryptophan, and 5-hydroxyindole-3-acetic acid may serve as potential candidates for further predictive validation in CKD progression in cats. Decreased uremic toxin excretion in rapidly progressive CKD may underlie disease progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jvim.70170","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T12:10:45Z","timestamp":1751890245000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic Alterations Associated With Rapidly Progressive Chronic Kidney Disease in Cats"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-5936","authenticated-orcid":false,"given":"Laurens","family":"Mulders","sequence":"first","affiliation":[{"name":"Ghent University Faculty of Veterinary Medicine, Department of Small Animals, , Merelbeke,","place":["Belgium"]},{"name":"Infectiology and Public Health, Laboratory of Integrative Metabolomics, Ghent University Faculty of Veterinary Medicine, Department of Translational Physiology, , Merelbeke,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7364-032X","authenticated-orcid":false,"given":"Ellen","family":"vanden van Broecke","sequence":"additional","affiliation":[{"name":"Ghent University Faculty of Veterinary Medicine, Department of Small Animals, , Merelbeke,","place":["Belgium"]},{"name":"Infectiology and Public Health, Laboratory of Integrative Metabolomics, Ghent University Faculty of Veterinary Medicine, Department of Translational Physiology, , Merelbeke,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2093-2561","authenticated-orcid":false,"given":"Femke","family":"Mortier","sequence":"additional","affiliation":[{"name":"Ghent University Faculty of Veterinary Medicine, Department of Small Animals, , Merelbeke,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"de Paepe","sequence":"additional","affiliation":[{"name":"Infectiology and Public Health, Laboratory of Integrative Metabolomics, Ghent University Faculty of Veterinary Medicine, Department of Translational Physiology, , Merelbeke,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Vanhaecke","sequence":"additional","affiliation":[{"name":"Infectiology and Public Health, Laboratory of Integrative Metabolomics, Ghent University Faculty of Veterinary Medicine, Department of Translational Physiology, , Merelbeke,","place":["Belgium"]},{"name":"School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast , Belfast,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6733-7925","authenticated-orcid":false,"given":"Sylvie","family":"Daminet","sequence":"additional","affiliation":[{"name":"Ghent University Faculty of Veterinary Medicine, Department of 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