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Another study demonstrated that while branched-chain amino acids (valine, leucine, and isoleucine) and taurine were significantly decreased, three metabolites of the kynurenine pathway, specifically 2-aminobenzoic acid, xanthurenic acid, and hydroxy picolinic acid were reported to be significantly upregulated in ESKD patients compared to CKD patients

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However, in chronic tendinopathy, its efficacy may be compromised due to persistent inflammation, tissue degeneration, fibrosis, and abnormal ECM composition, which can impede IGF-1 diffusion and diminish the responsiveness of tendon cells (Tang et al., 2024)