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Left atrial appendage closure in end-stage renal disease and hemodialysis: Data from a German multicenter registry

Thomas Fink1,2, Christina Paitazoglou3,4, Martin W Bergmann3

  • 1Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 22, 2023
PubMed

Insights

Left atrial appendage closure (LAAC) is a safe and effective stroke prevention method for atrial fibrillation patients with end-stage renal disease (ESRD). This approach demonstrated comparable outcomes to patients without severe kidney disease in a real-world study.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Left atrial appendage closure (LAAC) offers an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) patients.
  • While OAC is feasible in mild-to-moderate chronic kidney disease (CKD), optimal antithrombotic management for AF patients with end-stage renal disease (ESRD) remains unclear.
  • Prospective randomized trials have not yet established the efficacy of LAAC in ESRD patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of LAAC in patients diagnosed with end-stage renal disease (ESRD).

Main Methods:

  • A multicenter, real-world observational registry in Germany collected data on patients undergoing LAAC.
  • A composite endpoint included ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding.
  • Patients with ESRD (glomerular filtration rate < 15 mL/min/1.73 m² or on chronic hemodialysis) were propensity score-matched with patients without severe CKD.

Main Results:

  • The study analyzed 604 patients, including 57 with ESRD and 57 matched controls.
  • Major complication rates were comparable: 8.8% in ESRD patients versus 10.5% in matched controls (p=0.75).
  • Estimated event-free survival at 500 days for the composite endpoint was similar: 90.7% ± 4.5% in ESRD patients and 90.2% ± 5.5% in controls (p=0.33).

Conclusions:

  • Left atrial appendage closure (LAAC) demonstrates comparable procedural safety and clinical efficacy in patients with end-stage renal disease (ESRD) compared to those without severe CKD.
Abstract

Keywords:
chronic kidney diseasehemodialysisleft atrial appendage closurerenal failurestroke

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