BACKGROUND AND AIM: Disproportionally high exposures to arsenic (As), cadmium (Cd) and lead are nephrotoxic. However, epidemiological studies evaluating low-chronic exposure, especially for other metals, are limited. We assessed the cross-sectional and prospective associations of a panel of metals, individually and as mixtures, with albuminuria and estimated glomerular filtration rate (eGFR), two well-established markers of renal function. METHODS: 1519 participants from the Aragon Worker’s Health Study had available cobalt (Co), copper (Cu), molybdenum (Mo), zinc (Zn), As, barium (Ba), Cd, chromium (Cr), antimony (Sb), titanium (Ti), uranium (U), vanadium (V) and tungsten (W) urinary measurements. In a subset of 707 participants with available follow-up, we estimated annual-average increase of urine albumin and eGFR. The joint association of metals were evaluated implementing Bayesian Kernel Machine Regression (BKMR) methods. RESULTS:Median metal levels were 0.24, 7.0, 18.6, 295, 3.1, 1.9, 0.25, 0.99, 0.20, 9.7, 0.03, 0.50, 0.22 μg/g creatinine for Co, Cu, Mo, Zn, As, Ba, Cd, Cr, Sb, Ti, U, V and W, respectively. Increased urinary Co, Cu, Zn, As, Cr, Ti, U and W were associated with higher odds of albuminuria ≥30 mg/g. In BKMR analysis, these associations seemed to be driven by W, As and Zn. In prospective analyses, increased Cu, As and Cr were also related with higher odds of annual-increase albumin excretion ≥20%. For eGFR, the prospective association with annual-eGFR change [mean difference in change (95% confidence interval)] was not statistically significant for most metals except for As [-0.35 (-0.70, -0.001)], Zn [-0.31 (-0.61, -0.01)] and Ba [0.38 (0.09, 0.67)], directionally consistent with and without urine creatinine adjustment. CONCLUSIONS:We identified W, As, Zn and Cr exposures as potential risk factors of renal dysfunction. Exposure reduction and mitigation interventions of metals may decrease renal disease risk. KEYWORDS: Heavy metals, Epidemiology, Outcomes