Abstract 4361892: CKD and CKM Syndrome: Accelerated Progression to Arrhythmias in a National Cohort
Bibliographic record
Abstract
Introduction: Chronic kidney disease (CKD), a key element of the AHA Cardiovascular-Kidney-Metabolic (CKM) framework, is increasingly recognized as an independent risk factor for arrhythmias, especially atrial fibrillation (AF). Studies like ARIC and recent guidelines highlight higher arrhythmia risk with declining kidney function, but real-world data (RWD) on this progression are limited. This study examines arrhythmia onset in patients progressing from obesity to CKD. Methods: We conducted a retrospective real-world evidence study using the Symphony Integrated Dataverse (2018–2024) to examine arrhythmia development in adults with obesity initially classified as CKM Stage 1—defined by the absence of metabolic or cardiac risk factors at the time of obesity diagnosis (Fig. 1). A subset who progressed to CKD (Stages 1–4) but remained free of cardiac risk factors at CKD onset, were followed longitudinally to evaluate the incidence of major arrhythmias. All patients had a minimum of 12 months of baseline (lookback) data and 12 months of follow-up after their initial obesity diagnosis. Results: The cohort included 3.5 million adults with obesity (33% male, 67% female; median age 37 years) (Fig. 2). Of these, 26,478 patients (41% male, 59% female; median age 60 years) progressed to CKD: Stage 1 (7%), Stage 2 (32%), Stage 3 (57%), and Stage 4 (3%). After CKD onset, 1,095 patients (4%) (54% male, 46% female; median age 70 years) developed a major arrhythmia—65% atrial fibrillation (AF), 14% supraventricular tachycardia, 16% atrioventricular block, and 3% ventricular tachycardia—within a median of 4 months (Fig. 3). Between obesity diagnosis and CKD development, 27% developed hypertension, 12% diabetes, and 7% both (Fig. 4). Notably, 70% of all arrhythmia cases occurred in patients with CKD Stage 3. Conclusion: In this real-world cohort, progression from cardiometabolic dysfunction to CKD was associated with a marked rise in new arrhythmias, particularly AF. Early-onset obesity patients who developed CKD had a markedly higher progression to arrhythmia or MACE before age 40. These findings support CKD as a key inflection point in arrhythmia risk and reinforce the CKM framework. Enhanced surveillance for arrhythmias may be warranted as kidney function declines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".