Schulz CA, Engström G, Nilsson J, et al. - Considering the previous works establishing the association of the kidney injury molecule-1 (KIM-1) with kidney function in rodents and humans, researchers sought to determine its role as a predictive marker for future decline in kidney function. Measurement of fasting plasma KIM-1 (p-KIM-1) was done at baseline (1991–1994) in 4,739 participants of the population-based Malmö Diet and Cancer Study. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and cystatin C according to Chronic Kidney Disease Epidemiology Collaboration Collaboration 2012 creatinine–cystatin C equation at baseline and follow-up examination (2007–2012). An eGFR < 60 mL/min/1.73 m² at follow-up defined incident CKD. In multivariate analyses, participants with baseline p-KIM-1 levels in the highest quartile exhibited a higher risk for incident CKD at the follow-up examination than those within the lowest quartile. The addition to p-KIM-1 to a conventional risk model led to a significant improvement in C-statistics and reclassification of 9% of the individuals into the correct risk direction. Furthermore, an increase in the risk for hospitalization due to impaired renal function was noted with increasing baseline p-KIM-1 during a mean follow-up time of 19.2 years. Outcomes thereby support the predictive value p-KIM-1 for the future decline of eGFR and risk of CKD in healthy middle-aged participants.