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

Abstract

BackgroundChronic kidney disease (CKD) and kidney failure with replacement therapy (KFRT) are prevalent in patients with atrial fibrillation (AF). ObjectiveTo analyze procedural and long-term outcomes in AF patients with underlying CKD and KFRT after left atrial appendage occlusion (LAAO) device implantation. MethodsData 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 three groups: no CKD, CKD, and KFRT. Multivariate analyses were utilized to assess the associations of CKD and KFRT with procedural and long-term outcomes, respectively. ResultsA 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 (OR 1.149, 95% 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 (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). ConclusionCKD 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.