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A better understanding of the pathophysiology involving coronary artery calcification (CAC) in patients on hemodialysis (HD) will help to develop new therapies. We sought to identify the differences in metabolomics profiles between patients on HD with and without CAC. In this case-control study, nested within a cohort of 568 incident patients on HD, the cases were patients without diabetes with a CAC score 100 ( =51), and controls were patients without diabetes with a CAC score of zero ( =48). We measured 452 serum metabolites in each