Distribution and Clinical Utility of the Kidney Disease Improving Global Outcomes Chronic Kidney Disease Risk Classification in Patients Undergoing Atrial Fibrillation Ablation

BACKGROUND: Chronic kidney disease (CKD) is a key component of the cardiovascular-kidney-metabolic framework. However, in patients undergoing atrial fibrillation ablation, the distribution of CKD across Kidney Disease: Improving Global Outcomes risk categories and its prognostic value remain unclear. METHODS: Patients undergoing atrial fibrillation ablation with preprocedural urinalysis were studied. Patients were classified into Kidney Disease: Improving Global Outcomes 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 postdischarge heart failure hospitalization incidence across risk categories and assessed cardiovascular-kidney-metabolic multimorbidity (all 3 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 Kidney Disease: Improving Global Outcomes 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 heart failure. Heart failure hospitalization incidence increased across CKD risk categories (p<0.001), with a marked rise from moderate to high risk (1.90 [95% CI, 1.26-2.74] versus 7.74 [95% CI, 5.66-10.30] events per 100 person-years). Cardiovascular-kidney-metabolic multimorbidity occurred in 42% of the high- and 67% of the very-high-risk patients. The use of sodium-glucose cotransporter 2 inhibitors was 19% in the moderate-risk group and 27% in the high-risk group, compared with 62% in the very high-risk group. CONCLUSIONS: Kidney Disease: Improving Global Outcomes CKD risk categories stratified long-term heart failure hospitalization risk after atrial fibrillation ablation, with a sharp increase at high risk.