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During a median of 2.46 year follow-up, 931 (16.68%) participants developed CKD. After fully adjusting for confounding factors, VAI was significantly associated with incident CKD (HR, 1.052; 95% CI 1.029-1.076, 0.001), and RKFD (HR, 1.077; 95% CI 1.041-1.114, 0.001). Moreover, compared to those with the lowest VAI quartiles, subjects with the highest quartiles had a higher risk of incident CKD (HR, 1.286; 95% CI 1.033-1.601, = 0.024), and RKFD (HR, 1.895; 95% CI 1.086-3.307, = 0.025). The risk of incident CKD also tended to in