Cardiovasc Drugs Ther. 2026 Jul 3. doi: 10.1007/s10557-026-07897-0. Online ahead of print.
ABSTRACT
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.
PMID:42397479 | DOI:10.1007/s10557-026-07897-0