Renal outcomes of early rhythm control in patients with atrial fibrillation and chronic kidney disease

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public Institution(s). Main funding source(s): The Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea BACKGROUND: Atrial fibrillation (AF) is associated with development of impaired renal function and chronic kidney disease (CKD). Early rhythm control initiated within 1 year of AF diagnosis is associated with a lower risk of adverse cardiovascular outcomes compared to usual care among patients recently diagnosed with AF. PURPOSE: This study aimed to assess the effects of early rhythm control on renal function in patients with AF and CKD, compared with rate control METHODS: This population-based cohort study included 4,151 patients with AF and CKD, from the Korean National Health Insurance Service database, undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005–2015. A composite renal outcome of ≥30% decline in estimated glomerular filtration rate (eGFR), acute kidney injury (AKI), and kidney failure was compared using propensity score overlap weighting. RESULTS: In the study population (39.1% female; median age: 70 years), a total of 628 composite renal outcome occurred during the median follow-up of 2.3 years. Early rhythm control, compared with rate control, was associated with lower risks of the composite renal outcome (weighted incidence rate: 4.1 vs. 5.3 per 100 person-years; weighted HR 0.78, 95% CI 0.65-0.94) and kidney failure (weighted HR 0.73, 95% CI 0.56-0.95). Trends toward lower risks of eGFR decline (weighted HR 0.89, 95% CI 0.58-1.37) and AKI (weighted HR 0.88, 95% CI 0.66-1.17) were observed in patients undergoing early rhythm control, compared with those undergoing rate control. CONCLUSION: Among patients with AF and CKD, early rhythm control was associated with a lower risk of progression of kidney disease, compared with rate control, highlighting the need for future randomized studies evaluating the benefits of early rhythm control on renal outcome among patients with AF. [Figure: see text]