Abstract: TH-OR049
Protein Carbamylation and Incident Cardiovascular Events in the Chronic Renal Insufficiency Cohort (CRIC)
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 05:00 PM - 05:10 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Kalim, Sahir, Mass General Brigham Inc, Boston, Massachusetts, United States
- Tang, Mengyao, Mass General Brigham Inc, Boston, Massachusetts, United States
- Berg, Anders H., Cedars-Sinai, Los Angeles, California, United States
- Awwad, Aya, Mass General Brigham Inc, Boston, Massachusetts, United States
Background
Protein carbamylation is a urea-associated post-translational protein modification implicated in atherosclerosis, vascular calcification, and inflammation. While elevated carbamylation associates with mortality and kidney disease progression, its relationship to cardiovascular (CV) outcomes in non-dialysis CKD remains incompletely characterized.
Methods
We measured serum carbamylated albumin (C-Alb), a marker of carbamylation burden, in 2,973 participants with CKD 2–4 from the CRIC Study. Individuals with CV events prior to C-Alb measurement were excluded. The primary outcome was a composite of incident congestive heart failure, myocardial infarction, stroke, or peripheral arterial disease. Associations between C-Alb and outcomes were assessed using multivariable-adjusted Cox proportional hazards models.
Results
Median age was 61 years, median eGFR was 41.1 mL/min/1.73 m2, and median C-Alb was 7.7 mmol/mol. Over a median of 8.0 years follow-up (Q1,Q3: 3.90, 12.0), 900 of 2,973 participants developed the CVD outcome. Higher C-Alb was associated with greater CV risk. In fully adjusted models, each SD increase in C-Alb was associated with a 13% higher risk of the CV composite outcome (HR 1.13; 95% CI 1.05–1.22). Compared with participants in the lowest C-Alb quartile, those in the highest quartile had significantly greater CV risk (HR 1.29; 95% CI 1.02–1.62). Event burden increased across ascending quartiles of C-Alb (Figure 1).
Conclusion
Higher protein carbamylation burden independently associates with adverse CV outcomes in individuals with CKD stages 2–4. These findings further support carbamylation as a biologically relevant pathway linked to CV complications in CKD and a potential therapeutic target for future investigation.
Figure 1. Association of carbamylated albumin (C-Alb) with incident CV outcomes
(A) HRs (95% CIs) for the CVD outcome by C-Alb (continuous, per SD, and by quartile). Adjusted models include: age, sex, race/ethnicity, blood pressure, BMI, smoking, DM, baseline CVD, ACE-I/ ARB use, total albumin, hs-CRP, eGFR, proteinuria, cause of CKD.
(B) KM curves for the CV outcome by quartiles of C-Alb. Time (yrs).
Funding
- NIDDK Support