2191-P: Cardiometabolic–Kidney Staging and Mortality Outcomes in South Asians

Introduction and Objective: To examine associations between cardiovascular-kidney-metabolic (CKM) stages and cardiovascular disease (CVD) and all-cause mortality in South Asians, and to evaluate age-specific differences in these risks. Methods: We analyzed data from 17,430 (51% women; median age 42 y) adults in the cArdiometabolic Risk Reduction in South Asia (CARRS) cohort. We included participants from CARRS-1 (2010-12) and CARRS-2 (2014-16), with a median follow up of 9 y through 2024. CKM stages, based on the 2023 AHA CKM framework, were grouped as 0-1 (optimal/at-risk), 2 (metabolic risk or moderate-to-high risk CKD), and 3-4 (subclinical/clinical CVD or CKD). Cox models with age as the timescale estimated hazard ratios (HRs) for mortality, adjusting for sex, education, income, smoking, and included CKM × age interactions. Results: At baseline, 59% were in CKM stage 2 and 9% in stages 3-4. Compared with stage 0-1, adjusted HRs (95% CI) for CVD mortality for stage 2 were 2.9 (1.8, 4.9), 2.0 (1.4, 2.9), and 2.4 (1.2, 5.0), and for stages 3-4 were 13.0 (6.4, 26.1), 7.6 (5.3, 10.9), and 4.3 (2.1, 8.7) among those aged <45, 45-64, and ≥65 y, respectively. Similar trends were observed for all-cause mortality (Table). Conclusion: Advancing CKM stage was associated with progressively higher CVD and all-cause mortality, with the largest relative hazards at younger ages. These findings highlight the deleterious effects of early emergence of CKM in South Asians. Disclosure R. Jagannathan: None. W. Quarpong: None. D. Kondal: None. K. Singh: None. S.A. Patel: None. M. Deepa: None. R. Anjana: None. U. Gujral: None. S. Mohan: None. H.H. Chang: None. M.K. Ali: Consultant; Ended; Eli Lilly and Company, Siemens, Novo Nordisk. V. Mohan: None. A.A. Quyyumi: None. D. Prabhakaran: None. K. Narayan: None. S. Anand: Other - Site PI for VOICE study at US Renal Care; Current; US Renal Care. N. Tandon: None.