Distribution and clinical utility of the kidney disease improving global outcomes chronic kidney disease risk classification in patients undergoing atrial fibrillation ablation
H Ishiguchi, Y Yoshiga, S Hashimoto, M Fukuda, G Nakashima, M Fujinaka, M Shibuya, T Omuro, M SanoAbstract
Background
Chronic kidney disease (CKD) is a key component of the cardiovascular–kidney–metabolic (CKM) framework. However, in patients undergoing atrial fibrillation (AF) ablation, the distribution of CKD across Kidney Disease: Improving Global Outcomes (KDIGO) risk categories and its prognostic value remain unclear.
Methods
Patients undergoing AF ablation with preprocedural urinalysis were studied. Patients were classified into KDIGO CKD risk categories (Low, Moderate, High, Very high) using the estimated glomerular filtration rate and predicted urine albumin–creatinine ratio derived from dipstick proteinuria. We compared post-discharge heart failure (HF) hospitalization incidence across risk categories and assessed CKM multimorbidity (all three components present) and the use of kidney-protective therapies.
Results
Among 942 patients, 505, 277, 118, and 42 were classified as Low, Moderate, High, and Very high risk, respectively; 46.3% met the KDIGO definition of CKD (≥Moderate). Over a median follow-up of 5.1 years (interquartile range, 3.1–7.1), 72 patients (7.6%) were hospitalized for HF. HF hospitalization incidence increased across CKD risk categories (p<0.001), with a marked rise from Moderate to High risk (1.90 [95% confidence interval, 1.26–2.74] vs 7.74 [5.66–10.30] events per 100 person-years). CKM multimorbidity occurred in 42% of the High and 67% of Very high risk patients. The use of sodium–glucose cotransporter 2 inhibitors remained low in the Moderate (19%) and High (27%) groups.
Conclusion
KDIGO CKD risk categories stratified long-term HF hospitalization risk after AF ablation, with a sharp increase at High risk. Underuse of kidney-protective therapies was observed in the Moderate-to-High risk groups.Cumulative incidence of HF hospitalizationGraphical abstract