{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T22:56:09Z","timestamp":1781304969864,"version":"3.54.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist, and both increase the risk of thromboembolism and bleeding. We aim to investigate the impact of CKD in patients with AF undergoing left atrial appendage occlusion (LAAO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis using the TriNetX database, from April 2015 to February 2023. Patients aged \u2265 18 years with AF undergoing their first LAAO were included. We performed a comparative analysis of patients with CKD\/end-stage renal disease (ESRD) vs. those without. Propensity Score Matching (PSM) (1:1) was employed based on baseline characteristics. The primary outcomes were ischaemic stroke\/transient ischaemic attack (TIA)\/systemic embolism (SE) and major bleeding over a three-year follow-up. We included 10 689 patients, of whom 4140 had CKD\/ESRD, and 6549 had no CKD. PSM resulted in 3085 patients in each cohort. CKD\/ESRD was significantly associated with a higher risk of major bleeding [HR: 1.179, 95% CI (1.080, 1.288), P &amp;lt; 0.001], acute myocardial infarction, acute heart failure, acute kidney injury, cardiac-related haemodynamic instability (CRHI), hospitalizations, and all-cause mortality (P &amp;lt; 0.001), with no significant difference in ischaemic stroke\/TIA\/SE [HR: 1.019, 95% CI (0.909, 1.141), P = 0.750].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study suggests that CKD\/ESRD was significantly associated with a higher risk of major bleeding, acute myocardial infarction, acute heart failure, acute kidney injury, CRHI, hospitalizations, and all-cause mortality, with no significant difference in ischaemic stroke\/TIA\/SE among patients with AF undergoing LAAO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeag082","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:43:00Z","timestamp":1779363780000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of chronic kidney disease on clinical outcomes among patients with atrial fibrillation following percutaneous left atrial appendage occlusion: a multicentre cohort study"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2687-3880","authenticated-orcid":false,"given":"Ahmed Mazen","family":"Amin","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Mansoura University , 60 El Gomhouria Street, 35516 Mansoura ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5122-8200","authenticated-orcid":false,"given":"Ameer","family":"Awashra","sequence":"additional","affiliation":[{"name":"Department of Medicine, An Najah National University , Rafidia Street, P606 Nablus, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ubaid","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Maryland School of Medicine , 22 S. Greene St, Baltimore, Maryland 21201 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher V","family":"DeSimone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 First Street SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"2026061218085702700_oeag082-B1","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart disease and stroke statistics-2019 update: a report from the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"2026061218085702700_oeag082-B2","doi-asserted-by":"crossref","first-page":"2790","DOI":"10.1016\/j.jacc.2018.04.013","article-title":"Stroke prevention in nonvalvular atrial fibrillation: a stakeholder perspective","volume":"71","author":"Alkhouli","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026061218085702700_oeag082-B3","doi-asserted-by":"crossref","first-page":"e0158765","DOI":"10.1371\/journal.pone.0158765","article-title":"Global prevalence of chronic kidney disease\u2014a systematic review and meta-analysis","volume":"11","author":"Hill","year":"2016","journal-title":"PLoS One"},{"key":"2026061218085702700_oeag082-B4","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1093\/cvr\/cvaa258","article-title":"Pathophysiology of atrial fibrillation and chronic kidney disease","volume":"117","author":"Ding","year":"2021","journal-title":"Cardiovasc Res"},{"key":"2026061218085702700_oeag082-B5","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.ahj.2009.06.031","article-title":"Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the niigata preventive medicine study","volume":"158","author":"Watanabe","year":"2009","journal-title":"Am Heart J"},{"key":"2026061218085702700_oeag082-B6","doi-asserted-by":"crossref","first-page":"c4249","DOI":"10.1136\/bmj.c4249","article-title":"Low glomerular filtration rate and risk of stroke: meta-analysis","volume":"341","author":"Lee","year":"2010","journal-title":"BMJ"},{"key":"2026061218085702700_oeag082-B7","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1681\/ASN.2015050535","article-title":"The risk of Major hHaemorrhage with CKD","volume":"27","author":"Molnar","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"2026061218085702700_oeag082-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2014.04.029","article-title":"Prospective randomized evaluation of the watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial","volume":"64","author":"Holmes","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2026061218085702700_oeag082-B9","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0140-6736(09)61343-X","article-title":"Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial","volume":"374","author":"Holmes","year":"2009","journal-title":"Lancet (London, England)"},{"key":"2026061218085702700_oeag082-B10","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2026061218085702700_oeag082-B11","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1161\/01.CIR.84.1.223","article-title":"Assessment of left atrial appendage function by transesophageal echocardiography. 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