A diagram for the changes in plasma metabolites in CKD.

<p>The metabolite profiles of plasma in rats with CKD showed significantly increased levels of lactate, pyruvate, acetoacetate, β-hydroxybutyrate, glutamine, glutamate, and citrate. Metabolic acidosis is commonly complicated in CKD, due to both decreased net acid excretion and impaired regeneration of bicarbonate. This could change the citrate reabsorption in renal tubular cells, which metabolism generates HCO₃^– ions producing an alkalinizing effect. Moreover, increased protein breakdown and insensitivity to epinephrine in muscle in CKD could induce the increases of alanine, glutamate, and glutamine in plasma.