Adherence to healthy dietary patterns is associated with reduced risk of chronic kidney disease (CKD) progression and mortality in adults with CKD.1-3 However, diet is modifiable, and changes in diet quality may predict disease course and survival.4,5 Using data from the Chronic Renal Insufficiency Cohort (CRIC) Study, we assessed the associations of 4-year changes in diet quality with the subsequent risk of CKD progression and all-cause mortality in adults with CKD.