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Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study

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Abstract

Aims

Acute kidney injury (AKI) remains a frequent complication after cardiac interventions, such as left atrial appendage closure (LAAC), yet limited data are available on the incidence and clinical implication of AKI in this setting. We sought to assess incidence, predictors and relevance of AKI after LAAC.

Methods and results

We retrospectively analyzed 95 LAAC patients in three European centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) classification. The incidence of AKI was 13.7% with mild AKI in 92.3% and AKI stage > II in 7.7%. Total contrast volume was not linked to the occurrence of AKI (AKI: 127 ± 83 vs. no AKI: 109 ± 92 ml, p = 0.41), however increasing contrast volume (CV) to glomerular filtration rate (GFR) ratio (CV/GFR ratio) was associated with an increased risk of AKI (OR, per unit increase: 1.24, 95% CI 0.97–1.58, p = 0.08). ROC-analysis revealed a moderate predictive value of CV/GFR ratio for the prediction of AKI (AUC: 0.67, 95% CI 0.50–0.84, p = 0.05). Furthermore, AKI was associated with significantly increased mortality 6 months and 1 year after LAAC. No significant difference in the incidence of AKI was observed between patients with mere fluoroscopic and additional echocardiographic guidance (16.3% vs. 11.5%, p = 0.56).

Conclusion

Whereas mild AKI is common in patients after LAAC, severe AKI is rare. AKI after LAAC is associated with poor baseline renal function, increased doses of contrast (CV/GFR ratio) and impaired outcome. Future studies will be needed to elaborate the benefit of reducing or avoiding contrast volume regarding this endpoint.

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Abbreviations

ACP:

Amplatzer Cardiac Plug

AF:

Atrial fibrillation

AKI:

Acute kidney injury

AKIN:

Acute Kidney Injury Network

AUC:

Area under the curve

CHA2DS2-VASC:

CHA2DS2-VASC-Score

CI:

Confidence interval

CV:

Contrast volume

CV/GFR ratio:

Contrast volume to glomerular filtration rate ratio

CKD:

Chronic kidney disease

GFR:

Glomerular filtration rate

HAS-BLED:

HAS-BLED-score

KDIGO:

Kidney disease improving global outcomes

LAAC:

Left atrial appendage closure

LVEF:

Left ventricular ejection fraction

OAC:

Oral anticoagulation

OR:

Odds ratio

PCI:

Percutaneous coronary intervention

ROC:

Receiver operating characteristic

SD:

Standard deviation

TAVR:

Transcatheter aortic valve replacement

TEE:

Transesophageal echocardiography

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Acknowledgements

All co-authors contributed fully in terms of the design of the study, the evaluation of data, the actual manuscript preparation, and the revision and approval of the final submitted manuscript. As the corresponding author, Dr. Gloekler confirms that all authors have approved the final text.

Author information

Author notes

  1. Alexander Sedaghat and Vivian Vij contributed equally to this manuscript.

Authors and Affiliations

  1. Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany

    Alexander Sedaghat, Vivian Vij, Jan Wilko Schrickel, Baravan Al-Kassou, Dominik Nelles & Georg Nickenig

  2. Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland

    Samuel R. Streit, Stephan Windecker, Bernhard Meier, Marco Valglimigli & Steffen Gloekler

  3. Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland

    Fabian Nietlispach

  4. Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany

    Caroline Kleinecke

  5. Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, Villingen-Schwenningen, Germany

    Steffen Gloekler

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  1. Alexander Sedaghat
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Corresponding author

Correspondence to Steffen Gloekler.

Ethics declarations

Conflict of interest

Alexander Sedaghat has received travel grants from Abbott, Boston Scientific, Medtronic and Edwards Lifesciences. Baravan Al-Kassou has received travel grants from Abbott. Jan Wilko Schrickel has participated in clinical trials conducted by Abbott. Fabian Nietlispach is a consultant to Abbott, Edwards Lifesciences, and Medtronic. Marco Valgimigli reports research grants, advisory board and lectures fees from Abbott; Stephan Windecker received grants to the institution from Abbott, Biotronik, Boston Scientific, Medtronic and Edwards Lifesciences; Bernhard Meier received speaker and proctor fees from Abbott. Georg Nickenig has received speaker honoraria from Abbott. Steffen Gloekler received institutional grants from Abbott and a grant from the Swiss Heart Foundation. The other authors have no conflicts of interest.

Ethical approval

Declaration of Helsinki: The authors state that the study complies with the Declaration of Helsinki. The locally appointed ethics committee has approved the research protocol. Informed consent has been obtained from the subjects.

Electronic supplementary material

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Supplemental Table

 3 Clinical characteristics depending on periprocedural imaging modalities (DOCX 16 kb)

Supplemental Table

 4 Multivariate analysis for independent predictive value for 1-year mortalities (DOCX 17 kb)

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Sedaghat, A., Vij, V., Streit, S.R. et al. Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study. Clin Res Cardiol 109, 444–453 (2020). https://doi.org/10.1007/s00392-019-01524-9

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  • DOI: https://doi.org/10.1007/s00392-019-01524-9

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