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.

中文翻译：

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尿毒症毒素检测和监测在慢性肾病进展至终末期肾病管理中的进展

终末期肾病 (ESKD) 患者依靠透析来清除毒素并维持生命。然而，仅靠血液透析不足以完全清除所有/主要尿毒症毒素，导致特定毒素随着时间的推移而积累。尿毒症毒素的复杂性及其在不同透析方式中不同的清除率带来了重大挑战，人们正在研究微流体、生物标志物发现和即时检测等创新方法。本综述探讨了尿毒症毒素定性和定量分析的最新进展，并重点介绍了创新方法的使用，特别是主要用于定性检测的标记介导和无标记表面增强拉曼光谱。分析尿毒症毒素的能力可以优化血液透析设置，以更有效地去除毒素。多个组学学科的整合还将有助于识别生物标志物并了解 ESKD 的发病机制，提供对尿毒症毒素分析的更深入了解，并为改进血液透析计划提供见解。这篇综述还强调了早期发现和提高对慢性肾脏病的了解对于改善患者预后的重要性。