Steinbrenner I, Schultheiss UT, Kotsis F, et al. - Because there is no complete understanding of the mechanisms underlying the variable course of disease progression in patients suffering from chronic kidney disease (CKD), researchers herein focused on detecting novel biomarkers of adverse renal outcomes as well as overall mortality, which may offer further understanding of pathophysiological mechanisms. In this metabolome-wide association study, analysis of 5,087 CKD patients who were enrolled in the observational German Chronic Kidney Disease study was done. A total of 55 urine metabolites were found, whose concentrations were significantly related to adverse renal outcomes and/or mortality. A consistent link with all three main endpoints [kidney failure (KF), KF+AKI (acute kidney injury), death] was demonstrated by higher levels of C-glycosyltryptophan. Significant enrichment was displayed by metabolites belonging to the phosphatidylcholine pathway. Overall, metabolite that predicted KF was revealed via this comprehensive screen of the link between urine metabolite concentrations and adverse renal outcomes and mortality.