Abstract
Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.
PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I2 test.
Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15–6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33–1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70–2.03]; p = 0.53), pericardial effusion (1.22 [0.77–1.92]; p = 0.40), vascular complications (1.18 [0.92–1.52]; p = 0.20), or device related thrombus (1.13 [0.53–2.40]; p = 0.75).
This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.
•Left atrial appendage occlusion is recommended by European and American guidelines for stroke prevention in non-valvular atrial fibrillation and high risk of bleeding•Limited data is available for LAAO procedural safety and outcomes among patients with kidney disease where anticoagulation efficacy is reduced and bleeding risk is higher•This study shows increased risk of periprocedural mortality and bleeding with LAAO among patients with chronic and end stage kidney disease