Left Atrial Appendage Occlusion in Patients with End-Stage Renal Disease: An Individual Patient-Level Meta-Analysis

BACKGROUND: Patients with end-stage renal disease (ESRD) and atrial fibrillation (AF) present a challenge for thromboembolic prevention, given their elevated risks of both thromboembolism and bleeding. Anticoagulants carry a higher bleeding risk in this population without clear evidence of thromboembolic benefit. This study aims to define the role of left atrial appendage occlusion (LAAO) as a preventive strategy for patients with ESRD.

METHODS: A systematic literature review was conducted to identify studies reporting outcomes in patients with ESRD who underwent LAAO. Meta-analyses of aggregate and individual patient data were performed to evaluate acute and long-term outcomes and compare them with those of patients without ESRD.

RESULTS: Seventeen studies reporting data from 24,127 patients, including 1,047 with ESRD, were included. Procedural complications were more common in patients with ESRD (RR 2.23; P = 0.02), with a pooled rate of 4% (95%CI, 1-9%). There was no significant difference in thromboembolic event rates during follow-up between the groups (IRR 1.44; P = 0.16), but major bleeding incidence was higher among patients with ESRD (IRR 1.84; P < 0.01). Individual patient-level data from seven studies comprising 4,745 patients (268 with ESRD) were obtained and analyzed. Similarly, there was no significant association between ESRD and stroke/TIA incidence (HR 1.22 95% CI 0.66-2.26), but major bleeding was higher on patients with ESRD (HR 1.65 95% CI 1.01-2.69).

CONCLUSION: LAAO represents a feasible option for thromboembolic prevention in patients with ESRD, although these patients have an increased risk of complications and bleeding.