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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Acute Kidney Injury After Percutaneous Left Atrial Appendage Occlusion: Incidence, Risk Factors, Clinical Impact, and Contrast-Sparing Strategies—A Systematic Review

  • Josipa Radić1,2
  • Tina Bečić3
  • Marijana Vučković1
  • Mislav Radić2,4
  • Ivana Jukić5,6
  • Jonatan Vuković2,5
  • Damir Fabijanić3,7
7 affiliations
  1. 1Department of Internal Medicine, Division of Nephrology, Dialysis and Arterial Hypertension, University Hospital of Split, 21000 Split, Croatia
  2. 2Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
  3. 3Department of Cardiovascular Diseases, University Hospital of Split, 21000 Split, Croatia
  4. 4Department of Internal Medicine, Division of Rheumatology, Allergology and Clinical Immunology, University Hospital of Split, 21000 Split, Croatia
  5. 5Department of Internal Medicine, Division of Gastroenterology, University Hospital of Split, 21000 Split, Croatia
  6. 6Faculty of Health Sciences, University of Split, 21000 Split, Croatia
  7. 7Department of Clinical Propedeutics, School of Medicine, University of Split, 21000 Split, Croatia
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Abstract

Background: Acute kidney injury (AKI) is a clinically relevant complication following percutaneous left atrial appendage occlusion (LAAO). This systematic review evaluated its incidence, predictors, and clinical impact while separately examining the procedural feasibility and renal outcomes of contrast-sparing and zero-contrast LAAO strategies. Methods: PubMed, Web of Science, Scopus, and Cochrane CENTRAL were searched from database inception through 6 October 2026. Eighteen studies met the eligibility criteria. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively, with AKI-focused evidence considered separately from contrast-sparing procedural studies. Results: Four studies primarily evaluated AKI following conventional LAAO. Three creatinine-based cohorts reported AKI incidences ranging from 5.3% to 13.7%, whereas one large administrative database study reported coded AKI in 5.3% of index hospitalizations; these estimates were not considered directly comparable. Pre-existing renal dysfunction was the most consistent marker of AKI susceptibility, and AKI was associated with adverse clinical outcomes. Fourteen studies evaluated contrast-sparing or zero-contrast approaches and generally demonstrated high procedural success. However, renal outcomes were inconsistently assessed; several studies did not systematically report AKI, and AKI occurred even after zero-contrast implantation. Conclusions: Available evidence supports the procedural feasibility of contrast-sparing and zero-contrast LAAO but does not establish that contrast avoidance prevents AKI or provides a proven nephroprotective benefit. A renal-tailored framework remains hypothesis-generating and requires prospective comparative validation using standardized renal endpoints.

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Cite

BibTeXRIS
BibTeX
@article{radic2026acute,
  title = {{Acute Kidney Injury After Percutaneous Left Atrial Appendage Occlusion: Incidence, Risk Factors, Clinical Impact, and Contrast-Sparing Strategies—A Systematic Review}},
  author = {Josipa Radić and Tina Bečić and Marijana Vučković and Mislav Radić and Ivana Jukić and Jonatan Vuković and Damir Fabijanić},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207919},
  url = {https://www.mdpi.com/2077-0383/15/20/7919},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Acute Kidney Injury After Percutaneous Left Atrial Appendage Occlusion: Incidence, Risk Factors, Clinical Impact, and Contrast-Sparing Strategies—A Systematic Review
AU  - Josipa Radić
AU  - Tina Bečić
AU  - Marijana Vučković
AU  - Mislav Radić
AU  - Ivana Jukić
AU  - Jonatan Vuković
AU  - Damir Fabijanić
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207919
UR  - https://www.mdpi.com/2077-0383/15/20/7919
AB  - Background: Acute kidney injury (AKI) is a clinically relevant complication following percutaneous left atrial appendage occlusion (LAAO). This systematic review evaluated its incidence, predictors, and clinical impact while separately examining the procedural feasibility and renal outcomes of contrast-sparing and zero-contrast LAAO strategies. Methods: PubMed, Web of Science, Scopus, and Cochrane CENTRAL were searched from database inception through 6 October 2026. Eighteen studies met the eligibility criteria. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively, with AKI-focused evidence considered separately from contrast-sparing procedural studies. Results: Four studies primarily evaluated AKI following conventional LAAO. Three creatinine-based cohorts reported AKI incidences ranging from 5.3% to 13.7%, whereas one large administrative database study reported coded AKI in 5.3% of index hospitalizations; these estimates were not considered directly comparable. Pre-existing renal dysfunction was the most consistent marker of AKI susceptibility, and AKI was associated with adverse clinical outcomes. Fourteen studies evaluated contrast-sparing or zero-contrast approaches and generally demonstrated high procedural success. However, renal outcomes were inconsistently assessed; several studies did not systematically report AKI, and AKI occurred even after zero-contrast implantation. Conclusions: Available evidence supports the procedural feasibility of contrast-sparing and zero-contrast LAAO but does not establish that contrast avoidance prevents AKI or provides a proven nephroprotective benefit. A renal-tailored framework remains hypothesis-generating and requires prospective comparative validation using standardized renal endpoints.
SN  - 2077-0383
ER  -