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Yuni Choi,1 David R Jacobs Jr,1 Holly J Kramer,2 Gautam R Shroff,3 Alexander R Chang,4 Daniel A Duprez5 1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; 2Departments of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, IL, USA; 3Division of Cardiology and Department of Medicine, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis, MN, USA; 4Departments of Population of Health Sciences and Nephrology, Geisinger, Danville, PA, USA; 5Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USACorrespondence: Daniel A Duprez, Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN, 55455, USA, Tel + 1 612-624-4948, Fax + 1 612-626-4411, Email dupre007@umn.eduBackground: The prevalence of advanced chronic kidney disease (CKD) is higher in Black than in White Americans. We evaluated CKD progression in Black and White participants and the contribution of biological risk factors. We included the study of lung function (measured by forced vital capacity [FVC]), which is part of the emerging notion of interorgan cross-talk with the kidneys to racial differences in CKD progression.Methods: This longitudinal study included 2175 Black and 2207 White adult Coronary Artery Risk Development in Young Adults (CARDIA) participants. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured at study year 10 (age 27– 41y) and every five years for 20 years. The outcome was CKD progression through no CKD, low, moderate, high, or very high-risk categories based on eGFR and UACR in combination. The association between race and CKD progression as well as the contribution of risk factors to racial differences were assessed in multivariable-adjusted Cox models.Results: Black participants had higher CKD transition probabilities than White participants and more prevalent risk factors during the 20-year period studied. Hazard ratios for CKD transition for Black (vs White participants) were 1.38 from No CKD into ≥ low risk, 2.25 from ≤ low risk into ≥ moderate risk, and 4.49 from ≤ moderate risk into ≥ high risk. Racial differences in CKD progression from No CKD into ≥ low risk were primarily explained by FVC (54.8%), hypertension (30.9%), and obesity (20.8%). In contrast, racial differences were less explained in more severe transitions.Conclusion: Black participants had a higher risk of CKD progression, and this discrepancy may be partly explained by FVC and conventional risk factors.Keywords: CKD progression, racial disparities, young adults, conventional risk factors, lung function