Efficacy and safety of patients with chronic kidney disease undergoing left atrial appendage closure for atrial fibrillation

Abstract

Background The relative safety and efficacy of left atrial appendage closure (LAAC) for atrial fibrillation (AF) in patients with chronic kidney disease (CKD) have not been well defined. To evaluate the results in this cohort, we conducted a systematic review and meta-analysis of observational studies. Methods We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception to January 2023 for all relevant studies. Our inclusion criteria were met by twelve observational studies that included 61324 patients altogether. Results Compared with no CKD group, in-hospital mortality (OR: 2.84, 95% CI: 2.12–3.81, p<0.01, I2 = 0%), acute kidney injury (AKI) (OR: 4.39,95% CI:4.00–4.83, P<0.01, I2 = 3%), major bleeding events (OR: 1.44, 95% CI: 1.29–1.60, p<0.01 I2 = 0%), and pericardial effusion/tamponade (OR 1.30; 95% CI 1.13–1.51, p < 0.01; I2 = 0%) were more common in the CKD group, especially in patients with end-stage renal disease (ESRD). No significant difference was observed in the occurrence of stroke (OR: 1.24, 95% CI: 0.86–1.78, P = 0.25, I2 = 0%), LAAC success rates (OR: 1.02, 95% CI: 0.33–3.16, p = 0.97, I2 = 58%) and vascular access complications (OR: 1.13, 95% CI: 0.91–1.39, p = 0.28, I2 = 0%) between the two groups. During the follow-up, there was no difference in the risk of stroke between the two groups. Conclusions CKD patients who receive LAAC have a greater risk of in-hospital mortality, AKI, pericardial effusion/tamponade, and major bleeding events than those without CKD, especially in patients with ESRD. No significant difference in the risk of stroke was found in the long-term follow-up after LAAC between the two groups, demonstrating a similar efficacy of LAAC to prevent stroke in CKD patients.

Treatment strategies of the thromboembolic risk in kidney failure patients with atrial fibrillation

“…Information on long-term outcomes after LAAC showed a comparable incidence of stroke between patients with CKD at any stage and those with preserved kidney function [OR 1.33 (95% CI 0.53–3.34)]. As expected, the incidence of bleeding [OR 1.67 (95% CI 1.45–1.92)] and mortality [OR 3.45 (95% CI 2.01–5.92)] was higher in patients with CKD [ 75 ]. Some studies comparing the safety and efficacy of the procedure in patients with kidney failure versus populations with preserved or otherwise improved kidney function have come to encouraging conclusions, demonstrating comparable procedural safety and clinical efficacy in patients with kidney failure and patients without advanced CKD [ 77–79 ].…”

“…However, data on this topic are scarce and fragmentary and, above all, limited to a comparison of efficacy and safety of LAAC between patients with preserved kidney function and patients with advanced CKD. A recent meta-analysis that analysed data derived from the main available observational studies showed an increase in in-hospital adverse outcomes: in-hospital mortality [OR 8.61 (95% CI 5.9–12.5)], major bleeding [OR 1.63 (95% CI 1.33–2.01)] and pericardial effusion/tamponade [OR 1.54 (95% CI 1.17–2.03)] in kidney failure patients compared with non-kidney failure patients [ 75 ]. This finding is not surprising, as an increased risk of complications has also been described with other invasive cardiologic procedures in kidney failure patients [ 76 ].…”