Impact of Chronic Kidney Disease on Clinical Outcomes among Patients with Atrial Fibrillation Following Percutaneous Left Atrial Appendage Occlusion: A Multicenter Cohort Study

Abstract Background Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist, and both increase the risk of thromboembolism and bleeding. We aim to investigate the impact of CKD in patients with AF undergoing left atrial appendage occlusion (LAAO). Methods We conducted a retrospective analysis using the TriNetX database, from April 2015 to February 2023. Patients aged ≥ 18 years with AF undergoing their first LAAO were included. We performed a comparative analysis of patients with CKD/end-stage renal disease (ESRD) versus those without. Propensity Score Matching (PSM) (1:1) was employed based on baseline characteristics. The primary outcomes were ischemic stroke/transient ischemic attack (TIA)/systemic embolism (SE) and major bleeding over a three-year follow-up. Results We included 10,689 patients, of whom 4,140 had CKD/ESRD, and 6,549 had no CKD. PSM resulted in 3,085 patients in each cohort. CKD/ESRD was significantly associated with a higher risk of major bleeding (HR: 1.179, 95% CI [1.080, 1.288], p < 0.001), acute myocardial infarction, acute heart failure, acute kidney injury, cardiac-related hemodynamic instability (CRHI), hospitalizations, and all-cause mortality (p < 0.001), with no significant difference in ischemic stroke/TIA/SE (HR: 1.019, 95% CI [0.909, 1.141], p = 0.750). Conclusion Our study suggests that CKD/ESRD was significantly associated with a higher risk of major bleeding, acute myocardial infarction, acute heart failure, acute kidney injury, CRHI, hospitalizations, and all-cause mortality, with no significant difference in ischemic stroke/TIA/SE among patients with AF undergoing LAAO.