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Cardio-kidney-metabolic complexity in patients with atrial fibrillation: an analysis from the prospective GLORIA-AF

Giulio Francesco Romiti1,2, Davide Antonio Mei1,3, Bernadette Corica1,3

  • 1Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.

Cardiovascular Diabetology
|October 11, 2025
PubMed

Insights

Cardio-Kidney-Metabolic (CKM) syndrome domains are common in atrial fibrillation (AF) patients. Increased CKM domains correlate with lower oral anticoagulant use and higher risks of death and cardiovascular events.

Area of Science:

  • Cardiology
  • Nephrology
  • Metabolic Disorders

Background:

  • Cardio-Kidney-Metabolic (CKM) syndrome involves complex interactions between cardiovascular, renal, and metabolic conditions.
  • Limited data exist on the epidemiology and clinical impact of CKM syndrome in atrial fibrillation (AF) patients.

Purpose of the Study:

  • To evaluate the prevalence and impact of CKM domains in a real-world cohort of AF patients.
  • To analyze the association between CKM domains, oral anticoagulant (OAC) use, and major adverse outcomes.

Main Methods:

  • Analysis of 16,070 AF patients from the GLORIA-AF Registry phase III study.
  • CKM domains defined by cardiovascular, renal, and metabolic comorbidities in patients with CHA 2 DS 2 -VASc score ≥ 1.
  • Multiple-adjusted regression analyses assessed the association of CKM domains with OAC use and primary composite outcome (all-cause death and major adverse cardiovascular events).

Main Results:

  • 12.0% of patients presented with all three CKM domains, showing geographical variation.
  • OAC use increased with the number of CKM domains.
  • The primary composite outcome incidence rose with increasing CKM domains, particularly in patients with three domains (HR: 1.69). The kidney domain was most associated with clinical outcomes.

Conclusions:

  • CKM domains are prevalent and geographically diverse in AF patients.
  • CKM syndrome negatively impacts OAC use.
  • Increased CKM domain burden is associated with detrimental prognostic effects, including higher risks of all-cause death and MACE.
Abstract

Keywords:
Atrial fibrillationCardio-kidney-metabolic syndromeCardio-renal-metabolic syndromeClinical complexity

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