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Introduction: Patients with renal impairment are considered a coronary artery disease (CAD) equivalent. Repeated coronary artery calcium (CAC) scoring has been recognized as a robust tool for tracking progression of atherosclerosis. Further, CAC progression is an important marker of future adverse event. However, the evidence for an independent association of renal function with CAC progression remains unclear. Hypothesis: To examine the cross-sectional association between renal function and CAC progression. Methods: From a 6-center, single ethnicity observational registry, a total of 10,033 asymptomatic adults (mean age: 51.1±8.5 years, 84.9% men) without prior history of CAD and stroke underwent 2 examinations, including CAC screening as part of a broader health study with an average of 3.3±1.9 years between baseline scan and follow-up scan. Estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) was ascertained using the modified MDRD formula, and was categorized as: ≥90 (normal), 60-89 (mildly decreased), and <60 (moderate-to-severely decreased) based on current guidelines. CAC progression was calculated as the difference between the square root of baseline and square root of follow-up CAC score ≥2.5. Results: During an 8.7-year follow-up (IQR, 6.4-10.6 years), CAC progression was found in 766 subjects (7.6%). The patients with more impaired renal function were older, likely to be women and higher prevalence of hypertension, diabetes mellitus, and dyslipidemia. Among patients with normal or mildly decreased renal function, no difference of the proportion was found according to the presence or absence of CAC progression. Yet, patients with moderate-to-severely decreased renal function of eGFR <60 had higher prevalence of CAC progression (7.3% vs. 4.5%) (Figure). Notably, multivariate logistic regression model revealed that impaired renal function was associated with the progression of CAC (Odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.00-1.33 for eGFR 60-89 and OR: 1.80, 95% CI: 1.31-2.42 for eGFR <60). Conclusions: Impaired renal function evoked a strong relationship with a higher risk of the progression of subclinical atherosclerosis as measured by CAC scoring. [ABSTRACT FROM AUTHOR]