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Funding Acknowledgements Nil Background and objectives Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events that are underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients. Methods Stage 3 and 4 CKD patients without previous cardiac disease underwent a comprehensive transthoracic and stress echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for the primary end point of a composite of all-cause death and major adverse cardiovascular events (MACE). The secondary end point was a composite of cardiovascular death and MACE. Results 243 patients (male 63%; mean age 59.2 ± 14.4 years) were followed for a median of 3.9 ± 2.7 years. 69 patients met the primary endpoint and 58 the secondary end point. Age (p &amp;lt; 0.01), history of diabetes mellitus (p &amp;lt; 0.01), indexed LV mass(LVMI) (p &amp;lt; 0.01), LV global longitudinal strain(GLS) (p &amp;lt; 0.01), indexed LA volume(LAVI) (p &amp;lt; 0.01), E/e’ ratio (p &amp;lt; 0.01) and LA strain (LAs) (p &amp;lt; 0.01) were independent predictors of death and MACE. On Cox proportional hazards regression analysis, LAs (p &amp;lt; 0.01) was the only independent predictor for the primary end point in a model accounting for age, diabetes mellitus, LVMI, LVGLS, E/e’ and LAVI. LAs remained an independent predictor for the secondary end point. Conclusions LAs is an independent predictor of death and MACE in CKD patients, in whom the predominant cardiac abnormality is diastolic impairment. LAs is a prognostic biomarker, reflecting alterations in diastolic function in CKD. Abstract P1709 Figure. Kaplan Meier curve of LAs

P1709 Left atrial strain: a novel prognostic marker in patients with chronic kidney disease