Proteomics and metabolomics as tools to unravel novel culprits and mechanisms of uremic toxicity: instrument or hype?

The development of proteomic and metabolomic technologies holds the promise to significantly impact patient management by improving diagnosis, unraveling more appropriate therapeutic targets, and enabling more precise prognosis of disease development. Proteomics and metabolomics have been applied with the aim of improving dialysis, defining uremic toxins, and unraveling their origin. Ideally, these technologies should inform us which proteomic or metabolomic compounds are subject to significant alterations of concentration or structure as a result of failing kidney function, and thus can be considered as potential uremic toxins. After a few years of applying these technologies in the area of uremic toxicity studies we are now in a position where we can estimate how and what they can contribute to the field. In this review we critically examine the current literature on the application of proteomics and metabolomics in the context of dialysis and uremic toxins. We highlight the most promising findings, indicate where we see the current need, and which future developments consequently are to be expected, given the technological constraints that undoubtedly exist.