We conducted a case-control study nested in the Predictors of Arrhythmic and Cardiovascular Risk in ESKD (PACE) cohort and compared serum metabolites and pathway scores between cases and controls. Cases were participants without diabetes with a coronary artery calcification (CAC) score >100 (n=51), whereas controls were those with a CAC score of 0 (n=48). Metabolites (m=247) and pathway scores were compared between cases and controls. We identified three metabolites and one pathway that remained significant after adjusting for age and race. aThere were 36 metabolites with variable importance in projection (VIP) score greater than one and P value <0.05. Two of these metabolites do not have Human Metabolome Database identification: lumazine (food component) and 3-hydroxybenzaldehyde (chemical), and they were not included in the pathway analysis. bAdjusted for age and race using each metabolite. cAdjusted for age and race using the first principal component of the pathways. CV, coefficient of variation; m, number of metabolites; n, number of participants; PLS-DA, partial least squares–discriminant analyses.