Association of acute kidney injury with outcomes in patients undergoing percutaneous left atrial appendage closure

Abstract

Objectives: Using a large nationally representative database, we aimed to examine risk factors for acute kidney injury (AKI) and its association with outcomes in patients undergoing percutaneous left atrial appendage closure (LAAC).Background: Previous small-scale studies have reported poor outcomes with AKI following percutaneous LAAC. Methods:We queried the Nationwide Readmission Database to identify LAAC procedures performed from 2016 to 2017. Multivariable logistic and linear regression models were used to identify risk factors for AKI and determine the association between AKI and clinical outcomes. The primary outcome of interest was in-hospital mortality.Results: Of 20,703 patients who underwent LAAC during the study period, 1,097(5.3%) had a diagnosis of AKI. Chronic kidney disease, non-elective admission, coagulopathy, weight loss, prior coronary artery disease, heart failure, diabetes mellitus, and anemia were independently associated with an increased risk of AKI after LACC. In patients undergoing LAAC, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 16.01; 95% CI,

Left Atrial Appendage Occlusion

“…Patients referred for LAAO are usually elderly and have a high (15%-25%) prevalence of chronic renal insufficiency. 17 , 78 , 79 , 80 Hence, these patients are at risk of developing acute kidney injury (AKI) after the procedure, which has been shown to carry major negative prognostic implications. In 1 study, the incidence of AKI after LAAO was 9%, and this was associated with a 2.5-fold increase in all-cause mortality at 18 months.…”

“… 80 In another study, AKI after LAAO was associated with a 60% higher readmission rate at 6 months. 79 Hence, efforts have been made to optimize iodine contrast usage in the procedure to mitigate the risk of AKI. Proof-of-concept studies have shown the utility of contrast-free LAAO aided by 3D TEE, ICE, or 3D ultrasound mapping ( Figure 12 ).…”

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

“…To see the LAA before and after closure during LAAC, contrast is routinely used. Approximately 10% to 13% of patients undergoing LAAC have reported AKI [29][30][31]. AKI after LAAC has previously been reported to be independently correlated with CKD [31].…”

Kairiojo Prieširdžio Ausytės Uždarymas Ir Susiję Iššūkiai

“…laikotarpiu. Siekiant sumažinti ŪIFN riziką, buvo stengiamasi optimizuoti jodo kontrasto naudojimą procedūros metu [35]. Pasitelkiant 3D TEE, IKE arba 3D ultragarsinį kartografavimą, galima procedūrą atlikti be kontrasto.…”