Kalim S, Berg A, Karumanchi SA, et al. - Given that protein carbamylation is associated with cardiovascular outcomes and mortality in dialysis dependent end stage kidney disease, researchers herein determined its impacts in earlier pre-dialysis stages of chronic kidney disease (CKD). Within the CRIC Study, they undertook two nested case-control studies. They compared cases and controls in each study, in terms of baseline carbamylated albumin concentrations (C-Alb, a validated carbamylation assay). Adjusting for baseline disparities, an elevated risk of CKD progression and mortality was observed in relation to the top tertile of C-Alb vs the bottom tertile. Findings showed that CKD progression was predicted by protein carbamylation, beyond traditional risks including eGFR and proteinuria. In this limited sample size, the observed link of carbamylation with mortality was smaller.