Metabolic Product Analysis Before and After Dialysis in Patients with End-Stage Renal Disease Caused by Different Primary Diseases

doi:10.3969/j.issn.1004-5775.2025.16.003

Abstract：Objective: To study the serum metabolites of patients with end-stage renal disease (ESRD) caused by two different primary diseases using gas chromatography-mass spectrometry (GC-MS) metabolomics technology, and to analyze the relationship between the differences in metabolic products before and after dialysis caused by different primary diseases. Methods: A total of 63 ESRD patients admitted to Guangzhou Red Cross Hospital in March 2023 were selected as the study subjects. Among them, 33 had diabetic nephropathy (DN), and 30 had hypertensive nephropathy (HN). Routine biochemical indicators were analyzed using an automatic biochemical analyzer, and serum metabolites were analyzed using GC-MS, detecting a total of 322 serum metabolites. Orthogonal partial least squares discriminant analysis (OPLS-DA) was used to compare the serum metabolic profiles of the two groups, and differential metabolites were screened based on VIP > 1. The fold change was analyzed to determine the relationship between differential metabolites, and enrichment analysis was performed using the SMPDB database to identify the metabolic pathways significantly affected before and after dialysis. Results: 24 routine biochemical indicators were detected, and there were statistically significant differences compared to DN (P < 0.05). A total of 19 differential metabolites were identified before dialysis, and 85 differential metabolites were identified after dialysis. The metabolic pathway with the highest impact common to both before and after dialysis was the tryptophan metabolism pathway. Before dialysis, the differential metabolites related to the tryptophan pathway were kynurenine and anthranilic acid; after dialysis, they were glutamic acid and indoleacetic acid. In terms of overall concentration levels, HN showed upregulation compared to DN. Conclusion: For ESRD patients caused by different primary diseases, regular monitoring of relevant biochemical indicators and tryptophan pathway-related metabolites can promote early and precise intervention or treatment of ESRD, reduce kidney function damage, and maximize the benefits of hemodialysis.