The Association of Chronic Kidney Disease With Outcomes Following Percutaneous Left Atrial Appendage Closure

Keerat Rai Ahuja; Robert W Ariss; Salik Nazir; Rohit Vyas; Anas M Saad; Michael Macciocca; George V Moukarbel

doi:10.1016/j.jcin.2021.06.008

The Association of Chronic Kidney Disease With Outcomes Following Percutaneous Left Atrial Appendage Closure

JACC Cardiovasc Interv. 2021 Aug 23;14(16):1830-1839. doi: 10.1016/j.jcin.2021.06.008.

Authors

Keerat Rai Ahuja¹, Robert W Ariss², Salik Nazir², Rohit Vyas², Anas M Saad³, Michael Macciocca¹, George V Moukarbel⁴

Affiliations

¹ Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA.
² Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA.
³ Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA. Electronic address: george.moukarbel@utoledo.edu.

PMID: 34412801
DOI: 10.1016/j.jcin.2021.06.008

Abstract

Objectives: The aim of this study was to investigate the associations of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with in-hospital and short-term outcomes using a large national database representative of contemporary clinical practice.

Background: CKD and ESRD are associated with increased risk for stroke and bleeding in patients with atrial fibrillation on oral anticoagulation. Left atrial appendage closure (LAAC) may provide a reasonable alternative for these patients; however, the impact of CKD and ESRD on in-hospital and short-term outcomes following LAAC remain largely unknown.

Methods: The Nationwide Readmissions Database was used to identify LAAC procedures from 2016 to 2017 in patients with no CKD, CKD (stages I-V), and ESRD. Multivariable logistic regression models were used to assess in-hospital and short-term outcomes. The primary outcome was in-hospital mortality.

Results: Of 21,274 patients who underwent LAAC during the study period, 3,954 (18.6%) had CKD and 571 (2.7%) had ESRD. ESRD was associated with increased risk for in-hospital mortality compared with no CKD (3.3% vs 0.4%; adjusted odds ratio: 6.48; 95% confidence interval: 3.35-12.50; P < 0.001) and CKD (3.3% vs 0.5%; adjusted odds ratio: 11.43; 95% confidence interval: 4.77-27.39; P < 0.001). CKD was associated with increased risk for in-hospital acute kidney injury or hemodialysis and stroke or transient ischemic attack. ESRD and CKD were associated with increased readmissions extending to 90 days compared with no CKD, and ESRD was associated with increased readmissions compared with CKD. There was no difference with respect to other in-hospital outcomes.

Conclusions: ESRD is associated with higher in-hospital mortality, and CKD is associated with higher rates of stroke or transient ischemic attack in patients undergoing LAAC. Further research is needed to assess the impact of CKD and ESRD on long-term outcomes in these patients.

Keywords: Watchman; chronic kidney disease; left atrial appendage closure; outcomes.

MeSH terms

Atrial Appendage* / diagnostic imaging
Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Cardiac Surgical Procedures*
Humans
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / epidemiology
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology
Treatment Outcome