Risk Factors and Outcomes of AKI after LAAC Operation: A Single-Center Observational Study from Mainland China

TL;DR

This study finds that acute kidney injury after a heart procedure is more common in patients with severe kidney disease and is linked to higher risks of death and complications.

Contribution

Identifies specific risk factors and outcomes of AKI after LAAC in Chinese patients, emphasizing CKD severity and hypertension.

Findings

AKI incidence was highest in patients with CKD stages 4–5 (25.0%) compared to others.

AKI after LAAC was associated with significantly higher 3-year mortality and cardiovascular events.

Lower BMI, hypertension, and advanced CKD were independent risk factors for AKI.

Abstract

This study aimed to investigate the predictors and
prognosis of acute kidney injury (AKI) occurrence among Chinese patients
following left atrial appendage closure (LAAC).

We
retrospectively enrolled 512 consecutive patients who underwent LAAC between
January 2014 and December 2019. AKI was clinically defined according to the
Kidney Disease Improving Global Outcomes serum creatinine criteria. Major adverse
cardiovascular events were defined as the composite of all-cause mortality,
readmission due to heart failure, cardiac surgery, systemic embolism, or bleeding
events.

The incidence of AKI was 5.3% and was highest in
patients with chronic kidney disease (CKD) stages 4–5 (25.0%), followed by
those with CKD stages 3a–3b (9.1%), and those with CKD stages 1–2 or without
CKD (3.9% only). Multivariate logistic regression showed that lower body mass
index (odds ratio [OR] = 0.889; 95% confidence interval [CI], 0.803–0.986;
p = 0.017), hypertension (OR = 5.577; 95% CI, 1.267–24.558; p = 0.023), and CKD stages 4–5 (OR = 6.729; 95% CI, 1.566–28.923; p =
0.010) were independent risk factors for AKI development after LAAC. AKI after
LAAC was associated with 3-year major adverse cardiovascular events (33.3% vs.
7.5%, p < 0.001) and all-cause mortality (11.1% vs. 0.9%, p < 0.001) compared to that in the non-AKI group.

AKI is
relatively common after LAAC in patients with a baseline impaired glomerular
filtration rate. Moreover, AKI after LAAC is mainly related to increased midterm
mortality and morbidity, which require more strategies for prevention and
treatment.

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