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Transradial access reduced rate of acute kidney injury
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PCI via transradial access was associated with a nearly 25% reduction in acute kidney injury compared with the transfemoral approach.
The risk of acute kidney injury may depend on whether the access site is transradial or transfemoral, according to the researchers. They aimed to compare risks for acute kidney injury and nephropathy requiring dialysis among patients from 47 hospitals in Michigan.
Injury as defined by serum creatinine increase of ≥0.5 mg/dL served as the primary outcome measure. Nephropathy requiring dialysis and post-procedural bleeding were the secondary endpoints.
The analysis included 82,225 PCI procedures performed between 2010 and 2012, of which 8,915 were transradial.
Adjusted analysis results indicated that transradial PCI yielded a reduction in acute kidney injury (OR=0.76; 95% CI, 0.62-0.92). Bleeding also decreased with transradial access, and the researchers noted a trend toward lower risk for nephropathy requiring dialysis.
A propensity-matched analysis that included 8,857 procedures per group also was conducted. Transradial access yielded a lower adjusted risk for acute kidney injury (OR=0.74; 95% CI, 0.58-0.96) and bleeding (OR=0.47; 95% CI, 0.36-0.63) in this group, as well. However, there was no difference reported for nephropathy requiring dialysis in the propensity-matched group.
The investigators reported an independent association between post-procedural bleeding and acute kidney injury (OR=2.86; 95% CI, 1.75-4.66) in the propensity-matched population. However, reduced bleeding associated with transradial access did not mediate the lower odds of injury in this group.
“Sensitivity analysis demonstrated that the observed association between access site and [acute kidney injury] could potentially be explained by a moderately strong unknown confounder,” the researchers concluded, adding that the reduced injury risk for transradial access should be further investigated.
Disclosure: The researchers report associations with Blue Cross Blue Shield of Michigan and the Agency for Healthcare Research and Quality.
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