Kidney Week

Abstract: FR-PO0539

Association of Kidney Tubule Health with Incident Cardiovascular Events in Community-Living Adults

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Postalcioglu, Merve, University of California San Francisco School of Medicine, San Francisco, California, United States

Merve Postalcioglu, MD, FASN

• Katz, Ronit, University of Washington, Seattle, Washington, United States

Ronit Katz, PhD

• Gutierrez, Orlando M., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Orlando M. Gutierrez, MD

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix, MD, FASN

• Shlipak, Michael G., University of California San Francisco School of Medicine, San Francisco, California, United States

Michael G. Shlipak, MD, MPH

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak, MD, MS

Background

Whether tubular health is associated with incident atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), independent of glomerular health, in community-living adults is unclear.

Methods

Using a case-cohort design, we measured baseline urinary tubular biomarkers in participants of the Multi-Ethnic Study of Atherosclerosis with incident ASCVD (n=580) and HF (n=397) events and in participants from a random subcohort (n=1014). Factor analysis grouped biomarkers as tubular injury (IL-18, KIM-1, MCP-1, YKL-40), synthetic function (EGF, UMOD), and reabsorptive function (α1m). Cox proportional hazards models weighted for the case-cohort design adjusted initially for demographics, CV risk factors, and markers of glomerular health (ACR and eGFR), and then simultaneously for the other factors.

Results

Median follow up was 16.8 years. At baseline in the subcohort, mean eGFR was 78±16 ml/min/1.73 m² and median ACR was 5.2 [IQR: 3.3, 11.0] mg/g. The incidence rates for ASCVD and HF were 0.9 (95% CI: 0.8, 1.1) and 0.4 (0.3, 0.5) %/year, respectively. Greater tubular injury and reduced reabsorptive function factors were associated with incident ASCVD and HF in models adjusted for eGFR and ACR, and when other factors were included (Table). The magnitude of these associations was similar to or greater than that observed for ACR. In contrast, tubule synthetic function and baseline eGFR were not associated with either outcome.

Conclusion

In community living persons, worse tubular injury and reabsorptive function were associated with CVD events above and beyond eGFR and ACR, suggesting independent and complementary associations with CVD beyond glomerular health.

Funding

• NIDDK Support