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BACKGROUND Pulsed-field ablation (PFA) has emerged as an effective modality for the treatment of atrial fibrillation. However, intravascular hemolysis and subsequent renal injury have been recognized as potential complications. Haptoglobin binds free hemoglobin and may influence susceptibility to hemolysis-related renal injury. OBJECTIVE To determine whether baseline haptoglobin levels are associated with early renal injury after PFA and to evaluate the feasibility of targeted haptoglobin supplementation. METHODS A total of 493 patients undergoing PFA were prospectively enrolled. Baseline haptoglobin and serial creatinine were assessed. Early renal injury (increase in creatinine ≥ 0.2 mg/dL within 24 h) was the primary exploratory endpoint; KDIGO-defined acute kidney injury (AKI) was secondary. Primary analyses were performed in 481 patients without haptoglobin supplementation (analytic cohort), while 12 selected high-risk patients with low baseline haptoglobin and postprocedural hemoglobinuria received intravenous haptoglobin as a separate exploratory supplementation cohort. RESULTS Among 481 analytic cohort patients without supplementation, early renal injury occurred in 16 patients (3.3%) and decreased across increasing haptoglobin tertiles. Baseline haptoglobin was associated with early renal injury (odds ratio: 0.985; P = 0.025; AUC, 0.69). According to KDIGO criteria, six patients (1.2%) met the definition of AKI. Among patients with baseline haptoglobin ≥ 80 mg/dL, haptoglobin decline correlated with PFA deliveries (r = 0.36; P < 0.001). In the exploratory supplementation cohort, hemoglobinuria resolved rapidly while renal function remained stable. CONCLUSION Lower baseline haptoglobin was associated with early renal injury after PFA, suggesting a role in susceptibility to hemolysis-related renal stress. Targeted supplementation appears feasible but requires validation.
Tanaka et al. (Fri,) studied this question.