Objective: Studies of people with normal or slightly impaired renal function offer a unique setting to explore the metabolic profiles associated with the early renal dysfunction. Design and method: In 578 randomly recruited Flemish, we assessed at a 5 year interval the multivariable-adjusted associations of estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) with 43 circulating metabolites quantified by non-targeted nuclear magnetic resonance spectroscopy. Significance of associations, expressed per 1-SD increment in the metabolites, were Bonferroni corrected. Results: At baseline (2005–2010), glycine was associated with a 1.81 lower eGFR (P = 0.011). At follow-up (2009–2013), threonine (-2.14) and glycine (-1.73) were cross-sectionally associated with lower eGFR (P < = 0.02) and aspartate (+2.23), leucine (+2.30) and 2 aminobutyrate (+2.12) with higher eGFR (P < = 0.0033). At follow-up, the odds ratio of having eGFR < 60 was 1.62 for threonine and 1.44 for glycine (P < = 0.039). Partial least squares analyses of baseline and follow-up data were confirmatory. For baseline glycan N acetylglucosamine residues (GlycA), a marker of systemic inflammation, the odds ratio of progressing towards follow-up eGFR < 60 vs. non-progressing (n = 49 vs. 529) was 1.85 (P = 0.0086). Baseline GlycA was a better predictor than 24 h microalbuminuria, increasing (P < = 0.0001) the integrated discrimination (+3.4%) and net reclassification (+40.1%) indexes. Pathway analysis pointed to aminoacyl-tRNA biosynthesis, glycine, serine and threonine metabolism, valine, leucine and isoleucine metabolism, and glycolysis or gluconeogenesis. Conclusions: The glycine to threonine pathway and systemic inflammation as reflected by GlycA are markers of early renal dysfunction, whereas protection against oxidative stress and anaplerotic energy supply from the catabolism of branched amino acids (leucine) might be protective.
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