Metabolomics in Chronic Kidney Disease: The Emerging Role in Detection and Diagnosis of Mineral and Bone Disorders

Chronic kidney disease (CKD) affects over 10% of the global population and is increasingly prevalent, placing a substantial strain on healthcare systems. In Malaysia, CKD prevalence rose from 9.05% in 2011 to 15.48% in 2018, largely driven by diabetes mellitus. CKD often progresses to mineral and bone disorders (CKD-MBD), a condition starting as early as stage 3a CKD, characterized by disturbances in mineral and bone metabolism that contribute to significant morbidity and mortality. Current diagnostic methods for CKD-MBD, including bone biopsy and imaging, have limitations such as invasiveness, cost, and insufficient sensitivity. Biochemical markers offer some insight but are often not robust enough for the accurate detection and diagnosis of the disease. New protein biomarkers such as sKhloto and FGF23 are restricted by methodological issues and conflicting research outcomes. Metabolomics, the study of small molecule metabolites, provides a promising alternative. By analyzing metabolic profiles in biological samples, metabolomics reveals detailed biochemical changes linked to CKD-MBD. Recent studies have identified certain key metabolites associated with CKD-MBD. Despite some inconsistencies existing across studies, metabolomics, especially when combined with advanced techniques and machine learning, may hold great potential for discovering novel biomarkers for CKD-MBD. This review provides a comprehensive overview of the emerging role of metabolomic profiling in the detection and diagnosis of CKD-MBD. It aimed to enhance the understanding of the disease at a molecular level and explore new avenues for improving the diagnosis and management of this complex condition.