Albuminuria, an early biomarker of kindey dysfuction, has been associated with an increased risk of adverse cardiovascular outcomes.[1], [2] Coronary artery calcification (CAC), a noninvasive marker of subclinical atherosclerosis, is a strong predictor of future cardiovascular events. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline recommends CAC screening as cardiovascular risk assessment in adults with chronic kidney disease (CKD).3 Coupled with the increasing prevalence of CKD, this calls for better understanding of the impact of CKD-related factors on the development of cardiovascular outcomes in the early disease process.

Previous studies that investigated the association between albuminuria and CAC were only based on a single measurement of urine albumin-to-creatinine ratio (UACR) level from the baseline.[4], [5], [6] In addition, these studies were mainly performed in the population of older individuals, among whom subclinical and overt cardiovascular and metabolic abnormalities may already be established and may contribute to the outcomes.[7], [8] However, few large-scale studies have tested dynamic mid- to late-life albuminuria patterns longitudinally in relation to subsequent CAC progression, making this association remains unknown. Investigating the contribution of dynamic albuminuria patterns among midlife adults before the onset of cardiovascular disease may advance our understanding of how dysfunction in kidney impacts cardiovascular outcomes. Thus, we aim to determine the association of dynamic mid- to late-life albuminuria patterns with subsequent CAC progression among individuals in the Coronary Artery Disease Risk Development in Young Adults (CARDIA) study.