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.