This interplay between renal dysfunction, inflammation, and malnutrition explains the superior prognostic value of this composite marker. Clinical Applications and Recommendations The clinical applications of CAR can be summarized as follows: Domain Application Early Detection Discriminating diabetic patients at risk of developing DKD Disease Prognostication Estimating the risk of CKD progression to ESRD and need for RRT Preoperative Risk Assessment Identifying CKD patients at higher risk of postoperative complications Mortality Prediction Estimating short- and medium-term mortality risk Guiding Clinical Management Identifying patients who warrant intensified clinical care Conclusion The Creatinine-to-Albumin Ratio (CAR) is a simple, cost-effective, and easily calculable biomarker derived from two routinely measured laboratory parameters. Current evidence demonstrates that it is a robust and independent predictor of CKD progression, mortality, and associated complications, outperforming its individual components. As ongoing research continues to validate its utility across diverse populations and clinical settings, CAR appears poised to become a standard tool in kidney health assessment and therapeutic decision-making, particularly in patients with diabetes, elderly individuals, and those with established CKD. References 1. Luo H, Chen X. Prognostic value of the serum creatinine/albumin ratio for 28-day mortality in heart failure: a retrospective cohort study. Frontiers in Cardiovascular Medicine. 2025;12:1586327. 2. Mao J, et al. Association of C-reactive protein to albumin ratio with progression of CKD and all-cause mortality in diabetic CKD. Journal of Endocrinological Investigation. 2026. PMID: 42412363. 3. Association of the C-reactive protein–to–albumin ratio (CAR) with clinical outcomes in chronic kidney disease patients undergoing surgery: a retrospective cohort analysis of the INSPIRE database. BMC Nephrology. 2026;27:169. 4. Combined measurement of KIM-1, SFRP4, and CAR for the diagnosis of diabetic kidney disease. Journal of Clinical Nephrology. 2025;25:1053-1058. 5. Comparison of Urine Albumin-to-Creatinine Ratio (UACR) and protein-to-creatinine ratio. Journal of the American Society of Nephrology. By the Head of the Department, Prof. Dr. Younis Abdul Ridha Al-Khafaji Al-Mustaqbal University the First in Iraq