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Published on: February 26, 2013
GLP-1 Agonists and Risk of Atrial Fibrillation in Non-Dialysis Chronic Kidney Disease
Parth Dhamelia1, Ninad Khandekar2, Srikanth Vallurupalli1
1Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Slot 501, AR, Little Rock, 72205, USA.
Background:
GLP1 receptor agonists (GLP-1 RAs) improve cardiorenal outcomes in chronic kidney disease (CKD) patients with obesity or type 2 diabetes. Whether GLP-1 RAs reduce risk of atrial fibrillation (AF) in CKD patients, especially in absence of diabetes or obesity, is unclear.
Objective:
Investigate association between GLP-1 RA use and AF in patients with CKD.
Methods:
Using the TriNetX US Collaborative Network, we identified patients with CKD without prior AF or kidney failure. First use of GLP-1 RA (exposure) served as index event. For non-users, an outpatient visit after chronic kidney disease diagnosis served as pseudo-index event. After 1:1 propensity score matching of users to non-users for baseline risk factors, the cohort was followed up from index/pseudo-index event up to 3 years, death, or end of study period. Primary outcome was incident AF; secondary outcomes were AF-related interventions (a composite of ablation therapy, left atrial appendage occlusion, cardioversion, or pacemaker implantation), heart failure exacerbation, use of antiarrhythmic therapy, major adverse cardiovascular events, kidney failure, major adverse kidney events, and death. Survival analyses were performed.
Results:
After propensity score matching, each cohort-GLP-1 RA and non-GLP-1 RA-had 37,768 patients with CKD without prior AF or kidney failure. Mean age was 67 ± 11 years; 55% female; 21% Black; 63% diabetic; mean body mass index, 34 ± 7 kg/m2; and mean eGFR, 49 ± 20 mL/min/1.73 m². GLP-1 RA cohort developed fewer atrial fibrillation (6.9%) than non-GLP-1 RA cohort (12.4%) with HR 0.59, 95% CI 0.56-0.62. Associations remained consistent in non-obese (HR 0.63, 95% CI 0.57-0.70), non-diabetic (HR 0.42, 95% CI 0.36-0.49), and non-diabetic + non-obese (HR 0.59, 95% CI 0.46-0.77) subgroups. Use of GLP-1 RA was also associated with lower risk of composite AF-related interventions (HR 0.58, 95% CI 0.55-0.61), heart failure exacerbation (HR 0.48, 95% CI 0.46-0.49), antiarrhythmic therapy (HR 0.6, 95% CI 0.56-0.65), major adverse cardiovascular events (HR 0.58, 95% CI 0.56-0.59), progression to kidney failure (HR 0.70, 95% CI 0.66-0.74), major adverse kidney events (HR 0.55, 95% CI 0.53-0.56), and death (HR 0.52; 95% CI, 0.49-0.55).
Conclusion:
In this retrospective cohort, use of GLP-1 RAs was associated with lower risk of AF in non-dialysis CKD patients, even those without diabetes or obesity.
Insights
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) significantly lower the risk of developing atrial fibrillation (AF) in patients with chronic kidney disease (CKD). This protective effect was observed even in individuals without diabetes or obesity.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are known to improve cardiorenal outcomes in chronic kidney disease (CKD) patients with obesity or type 2 diabetes.
- The potential benefit of GLP-1 RAs in reducing the risk of atrial fibrillation (AF) among CKD patients, particularly those without diabetes or obesity, remains unclear.
Purpose of the Study:
- To investigate the association between the use of GLP-1 receptor agonists (GLP-1 RAs) and the incidence of atrial fibrillation (AF) in patients diagnosed with chronic kidney disease (CKD).
Main Methods:
- A retrospective cohort study was conducted using the TriNetX US Collaborative Network.
- Patients with CKD but without prior AF or kidney failure were identified, with the first GLP-1 RA use serving as the index event for the exposure group.
- A 1:1 propensity score matching was performed between GLP-1 RA users and non-users, followed by up to 3 years of follow-up to assess the primary outcome of incident AF and secondary outcomes.
Main Results:
- After propensity score matching, 37,768 patients were included in both the GLP-1 RA and non-GLP-1 RA cohorts.
- GLP-1 RA use was associated with a significantly lower risk of developing AF (HR 0.59, 95% CI 0.56-0.62), with consistent findings across non-obese, non-diabetic, and combined non-diabetic/non-obese subgroups.
- GLP-1 RA use also demonstrated significant reductions in AF-related interventions, heart failure exacerbation, antiarrhythmic therapy, major adverse cardiovascular events, kidney failure, major adverse kidney events, and all-cause mortality.
Conclusions:
- The use of GLP-1 receptor agonists (GLP-1 RAs) is associated with a reduced risk of atrial fibrillation (AF) in patients with non-dialysis-dependent chronic kidney disease (CKD).
- This protective association extends to CKD patients even in the absence of diabetes or obesity.
- GLP-1 RAs may offer broader cardiovascular and renal protective benefits in the CKD population.
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