Association of chronic kidney disease and kidney failure with replacement therapy with procedural and long-term outcomes after first-generation Watchman device: Insights from the NCDR LAAO Registry.

BACKGROUND

Chronic kidney disease (CKD) and kidney failure with replacement therapy (KFRT) are prevalent in patients with atrial fibrillation (AF).

OBJECTIVE

The purpose of this study was to analyze procedural and long-term outcomes in AF patients with underlying CKD and KFRT after left atrial appendage occlusion (LAAO) device implantation.

METHODS

Data were extracted from the National Cardiovascular Data Registry LAAO Registry from January 2017 to December 2019 and linked to Centers for Medicare & Medicaid Services billing claims. Patients were stratified into 3 groups: no CKD, CKD, and KFRT. Multivariate analyses were used to assess the associations of CKD and KFRT with procedural and long-term outcomes, respectively.

RESULTS

A total of 59,190 patients were enrolled in our study. CKD and KFRT were found to be independently associated with any complication from the procedure (odds ratio [OR] 1.149, 95% confidence interval [CI] 1.058-1.;247 and OR 2.163, 95% CI 1.763-2.652) and in-hospital death (OR 1.603, 95% CI 1.054-2.437; and OR 5.488, 95% CI 2.686-11.213). At 1 year, CKD and KFRT were associated with a higher risk of any major adverse event (hazard ratio [HR] 1.402, 95% CI 1.333-1.474; and HR 2.506, 95% CI 2.236-2.809) and death (HR 1.662, 95% CI 1.553-1.779; and HR 3.422, 95% CI 2.989-3.919), but no difference in the competing risk of stroke (HR 0.972, 95% CI 0.819-1.152; and HR 0.794, 95% CI 0.434-1.451).

CONCLUSION

CKD and KFRT were associated with higher rates of procedural complications and 1-year adverse events and death, but no difference in the 1-year rate of stroke.