Abstract Disclosure: C.D. Martínez-Franco: None. F.J. Gomez-Perez: None. M. Vilatobá: None. R. Flores-Cárdenas: None. D. Cuevas-Ramos: None. Kidney Donors with Metabolic Syndrome Have Increased Risk for Chronic Kidney Disease Introduction: Metabolic syndrome (MetS) has a prevalence of 56% in Mexico, been a common cause of progressive deterioration of renal function. Renal donors usually have good health at the time of donation, but some cases already present MetS or develop it over time. Objective: to evaluate the risk of MetS on chronic kidney disease (CKD) in kidney donors. Methods: we performed a comparative, longitudinal, observational and prolective study at a tertiary care hospital from 1980 to 2023. MetS was defined with ATPIII criteria. Renal function was assessed with the CKD-EPI formula to obtain the eGFR prior to the date of transplantation and at last follow-up. Student's t test, chi-square test, Kaplan-Meier, and multivariate Cox regression analyses were performed to assess the independent risk of MetS on renal function. Results: A cohort of 406 patients was collected, 283 cases (58% women), where 96 (34%) showed MetS criteria, and 187 (66%) without them used as control. There was no significant baseline difference on CrCl before donation between control group (97±19 ml/min) vs. MetS group (95±17 ml/min, p=0.45). The median follow-up was 25 (20.2-29.7) years. To assess the outcome of CrCl <60 mL/min, 4 groups were analyzed according to their MetS status at baseline - last follow-up. The fastest decreased on CrCl was seen at group 3 (No MetS - With MetS) after 17 (95%CI 14-19) years of follow-up, then group 4 (MetS - MetS) after 19 (3-34) years, followed by group 2 (With MetS - No MetS) with 23 (10-35) years, and finally group 1 (No MetS - No MetS), after 27 (23.7-30.5) years (p<0.0001). Group 1 was taken as reference to calculate CKD risk between groups. MetS showed a statistically significant risk as an independent determinant for CKD at follow-up with a HR=1.6 (0.7-3.3, p=0.21), HR=2.9 (1.2-7.0, p=0.01) and HR=2.2 (1.1-4.4, p=0.02) for group 2, 3 and 4, respectively. Conclusions: Having or developing MetS on kidney donors caused significantly higher risk of presenting CKD at last follow-up. Clinicians should be aware of such risk to implement strategies for prevention and treatment of MetS, with close and chronic surveillance of such patients. Presentation: 6/1/2024