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

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.