{"doi":"10.1093/ckj/sfaf302","title":"Protein carbamylation is associated with increased mortality and CKD progression in patients with CKD: results from the EQUAL study","abstract":"Background and hypothesis: Urea accumulated in CKD patients' blood can spontaneously decompose into reactive isocyanate and bind to plasma proteins in a reaction called carbamylation. Recent studies suggest a direct link between protein carbamylation and the pathogenesis of cardiovascular events and mortality in dialysis patients. We investigated whether carbamylation of albumin (C-Alb) is associated with increased mortality, major adverse cardiovascular events, and need for dialysis in older patients with advanced CKD. Methods: The European Quality Study (EQUAL) is a multicentre prospective cohort study. CKD patients aged 65 or older with advanced CKD (eGFR ≤20 ml/min/1.73 m²) not on kidney replacement therapy were followed up for 5 years. In a subgroup of 1117 patients, C-Alb was measured at baseline using combined liquid chromatography and mass spectrometry. Multivariable analyses were adjusted for important confounders. Results: Mean C-Alb was 13.5 ± 6.5 mmol/mol. Men had higher C-Alb values than women, as well as patients with chronic heart failure compared to patients without. C-Alb correlated positively with age, creatinine, urea, and negatively with eGFR, but not with total albumin. Each unit increase of log-transformed C-Alb was associated with increased risk of overall mortality (adj. HR 1.92, 95%CI 1.40-2.64) and start of dialysis therapy (adj. HR 1.59, 95%CI 1.21-2.09). Conclusion: In older advanced CKD patients not on dialysis, increased levels of C-Alb were associated with higher mortality and need for dialysis.","journal":"Clinical Kidney Journal","year":2025,"id":527183,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9553,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1404513,"name":"AR Haas","orcid":null,"position":1,"is_corresponding":false},{"id":1403850,"name":"Nicholas C Chesnaye","orcid":"0000-0003-4883-9174","position":2,"is_corresponding":false},{"id":860272,"name":"Kitty J. Jager","orcid":"0000-0003-0444-8569","position":3,"is_corresponding":false},{"id":271629,"name":"Fergus Caskey","orcid":"0000-0002-5199-3925","position":4,"is_corresponding":false},{"id":1054920,"name":"Maria Pippias","orcid":"0000-0001-7469-4955","position":5,"is_corresponding":false},{"id":856093,"name":"Friedo W. Dekker","orcid":"0000-0002-2433-2494","position":6,"is_corresponding":false},{"id":1404514,"name":"Merel van Diepen","orcid":"0000-0003-3211-9500","position":7,"is_corresponding":false},{"id":857940,"name":"Marie Evans","orcid":"0000-0001-8650-5795","position":8,"is_corresponding":false},{"id":1404515,"name":"Claudia Torino","orcid":null,"position":9,"is_corresponding":false},{"id":1403851,"name":"Antonio Vilasi","orcid":"0000-0002-9393-2418","position":10,"is_corresponding":false},{"id":1403852,"name":"Maciej Szymczak","orcid":"0000-0002-1248-081X","position":11,"is_corresponding":false},{"id":74376,"name":"Christoph Wanner","orcid":"0000-0001-9507-5301","position":12,"is_corresponding":false},{"id":253969,"name":"Anders H. Berg","orcid":"0000-0002-5736-0686","position":13,"is_corresponding":false},{"id":275445,"name":"Christiane Drechsler","orcid":"0000-0002-0012-9707","position":14,"is_corresponding":false},{"id":1404512,"name":"Tilla C Folttmann","orcid":null,"position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":null,"created_at":"2026-07-19T02:50:39.280101Z","pmid":"41195289","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}