Abstract MPTH68: Proteinuria Reduction and Cardiovascular and Mortality Outcomes in Chronic Kidney Disease: Evidence Across the CKM Continuum

Introduction: Proteinuria reduction has consistently been associated with improved kidney outcomes in chronic kidney disease (CKD). However, whether reduction in proteinuria also translates into lower risk of specific cardiovascular outcomes remains less well established. We aimed to evaluate the association between 1-year change in proteinuria and subsequent risks of cardiovascular and mortality outcomes in CKD. Hypothesis: We hypothesized that greater reduction in proteinuria over one year would be independently associated with cardiovascular outcomes, irrespective of diabetes status. Methods: We studied 3,073 participants with established CKD in the Chronic Renal Insufficiency Cohort (CRIC) who had repeated 24-hour urine protein measurements at baseline and 1 year. Percent change in proteinuria was modeled continuously (restricted cubic splines) and categorically (≥30% vs 0.05). Conclusions: Across the CKM spectrum, greater reduction in proteinuria over one year was linearly and independently associated with lower risk of HF, MACE, and mortality—regardless of diabetes or CVD status. The MACE association was largely driven by lower HF events, underscoring the cardiorenal coupling of proteinuric injury. Proteinuria change represents a dynamic, actionable biomarker of CKM health and a potential surrogate endpoint for cardiorenal protection in CKD.