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

Sedaghat, Alexander; Vij, Vivian; Streit, Samuel R; Schrickel, Jan Wilko; Al-Kassou, Baravan; Nelles, Dominik; Kleinecke, Caroline; Windecker, Stephan; Meier, Bernhard; Valglimigli, Marco; Nietlispach, Fabian; Nickenig, Georg; Gloekler, Steffen (2020). Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study. Clinical research in cardiology, 109(4), pp. 444-453. Springer-Verlag 10.1007/s00392-019-01524-9

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1861-0684

Publisher:

Springer-Verlag

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

11 Feb 2020 08:27

Last Modified:

29 Mar 2020 01:34

Publisher DOI:

10.1007/s00392-019-01524-9

PubMed ID:

31278520

Uncontrolled Keywords:

Acute kidney injury Contrast dye volume Left atrial appendage closure Renal function

BORIS DOI:

10.7892/boris.139131

URI:

https://boris.unibe.ch/id/eprint/139131

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