ASSOCIATION OF RADIAL ARTERY ACCESS WITH REDUCED INCIDENCE OF ACUTE KIDNEY INJURY

Authors

  • MT RAZA National Institute of Cardiovascular Disease Karachi, Pakistan
  • B AKHTAR National Institute of Cardiovascular Disease Karachi, Pakistan
  • SM BABAR National Institute of Cardiovascular Disease Karachi, Pakistan
  • K MAL National Institute of Cardiovascular Disease Karachi, Pakistan
  • SNH RIZVI National Institute of Cardiovascular Disease Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1098

Keywords:

Radial Artery Access, Acute Kidney Injury, Cardiac Procedures, Femoral Artery, KDIGO Criteria

Abstract

Acute kidney injury (AKI) is a serious complication following cardiac procedures, leading to increased morbidity and mortality. The choice of vascular access site may influence the incidence of AKI, with radial artery access potentially offering protective benefits compared to femoral artery access. Objective: To evaluate the association between radial artery access during cardiac procedures and the incidence of acute kidney injury among patients. Methods: This retrospective cohort study was conducted at the National Institute of Cardiovascular Disease from January 2023 to January 2024. A total of 370 patients who underwent cardiac procedures were included, comprising 200 patients in the radial artery access group and 170 in the femoral artery access group. Data were collected retrospectively from medical records, including demographic information, baseline renal function, procedural details, and serum creatinine levels before and after the procedure. The incidence of AKI was determined based on established criteria for changes in serum creatinine. Statistical analyses were performed using appropriate tests, with a significance level set at p < 0.05. Results: Patients in the radial artery access group had a shorter average hospital stay (2.5 ± 1.2 days) compared to the femoral group (3.8 ± 1.5 days, p = 0.001). The mortality rate was lower in the radial group (1.5%) versus the femoral group (4.1%), although this difference was not statistically significant (p = 0.09). The incidence of major adverse cardiovascular events (MACE) was 2.5% in the radial group compared to 5.9% in the femoral group (p = 0.07). Acute kidney injury occurred in 10.0% of patients in the radial artery access group (20 out of 200) versus 17.6% in the femoral artery access group (30 out of 170), indicating a significant reduction in AKI incidence with radial access. Conclusion: Using radial artery access during cardiac procedures significantly reduces the incidence of acute kidney injury compared to femoral artery access. These findings support the preference for radial artery access to minimize the risk of AKI and improve patient outcomes.

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References

Andò G, Cortese B, Russo F, Rothenbühler M, Frigoli E, Gargiulo G, et al. Acute kidney injury after radial or femoral access for invasive acute coronary syndrome management: AKI-MATRIX. Journal of the American College of Cardiology. 2017;69(21):2592-603.

Steinvil A, Garcia-Garcia HM, Rogers T, Koifman E, Buchanan K, Alraies MC, et al. Comparison of propensity score–matched analysis of acute kidney injury after percutaneous coronary intervention with transradial versus transfemoral approaches. The American Journal of Cardiology. 2017;119(10):1507-11.

Shah R, Mattox A, Khan MR, Berzingi C, Rashid A. Contrast use in relation to the arterial access site for percutaneous coronary intervention: a comprehensive meta-analysis of randomized trials. World Journal of Cardiology. 2017;9(4):378.

Prasad A, Rosenthal NA, Kartashov A, Knish K, Dreyfus J. Contemporary trend of acute kidney injury incidence and incremental costs among US patients undergoing percutaneous coronary procedures. Catheterization and Cardiovascular Interventions. 2020;96(6):1184-97.

Wang C, Chen W, Yu M, Yang P. Comparison of acute kidney injury with radial vs. femoral access for patients undergoing coronary catheterization: An updated meta‑analysis of 46,816 patients. Experimental and Therapeutic Medicine. 2020;20(5):1-.

Marbach JA, Wells G, Di Santo P, So D, Chong A-Y, Russo J, et al. Acute kidney injury after radial or femoral artery access in ST-segment elevation myocardial infarction: AKI-SAFARI. American heart journal. 2021;234:12-22.

Chiarito M, Cao D, Nicolas J, Roumeliotis A, Power D, Chandiramani R, et al. Radial versus femoral access for coronary interventions: an updated systematic review and meta‐analysis of randomized trials. Catheterization and Cardiovascular Interventions. 2021;97(7):1387-96.

Tokarek T, Dziewierz A, Plens K, Rakowski T, Dudek D, Siudak Z. Radial approach reduces mortality in patients with ST-segment elevation myocardial infarction and cardiogenic shock. Pol Arch Intern Med. 2021;131(5):421-8.

Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. The Lancet. 2021;398(10315):1974-83.

Secemsky EA, Butala N, Raja A, Khera R, Wang Y, Curtis JP, et al. Temporal changes and institutional variation in use of percutaneous coronary intervention for ST-elevation myocardial infarction with multivessel coronary artery disease in the United States: an NCDR research to practice project. JAMA cardiology. 2021;6(5):574-80.

Fanaroff AC, Zakroysky P, Wojdyla D, Kaltenbach LA, Sherwood MW, Roe MT, et al. Relationship between operator volume and long-term outcomes after percutaneous coronary intervention: report from the NCDR CathPCI Registry. Circulation. 2019;139(4):458-72.

Mohebi R, Karimi Galougahi K, Garcia JJ, Horst J, Ben-Yehuda O, Radhakrishnan J, et al. Long-term clinical impact of contrast-associated acute kidney injury following PCI: an ADAPT-DES substudy. Cardiovascular Interventions. 2022;15(7):753-66.

Sinha SK, Jha MJ, Mishra V, Thakur R, Goel A, Kumar A, et al. Radial artery occlusion–incidence, predictors and long-term outcome after transradial catheterization: clinico-Doppler ultrasound-based study (RAIL-TRAC study). Acta Cardiologica. 2017;72(3):318-27.

van Leeuwen MA, Hollander MR, Van Der Heijden DJ, van de Ven PM, Opmeer KH, Taverne YJ, et al. The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access) A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization. Circulation: Cardiovascular Interventions. 2017;10(11):e005753.

Idris H, French JK, Shugman IM, Hopkins AP, Juergens CP, Thomas L. Influence of age and gender on clinical outcomes following percutaneous coronary intervention for acute coronary syndromes. Heart, Lung and Circulation. 2017;26(6):554-65.

Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology. 2017;126(1):47-65.

Lachance P, Villeneuve P-M, Rewa OG, Wilson FP, Selby NM, Featherstone RM, et al. Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review. Nephrology Dialysis Transplantation. 2017;32(2):265-72.

Bloom JE, Dinh DT, Noaman S, Martin C, Lim M, Batchelor R, et al. Adverse impact of chronic kidney disease on clinical outcomes following percutaneous coronary intervention. Catheterization and Cardiovascular Interventions. 2021;97(6):E801-E9.

Gargiulo G, Giacoppo D, Jolly SS, Cairns J, Le May M, Bernat I, et al. Effects on mortality and major bleeding of radial versus femoral artery access for coronary angiography or percutaneous coronary intervention: meta-analysis of individual patient data from 7 multicenter randomized clinical trials. Circulation. 2022;146(18):1329-43.

Doll JA, Beaver K, Naranjo D, Waldo SW, Maynard C, Helfrich CD, et al. Trends in arterial access site selection and bleeding outcomes following coronary procedures, 2011–2018. Circulation: Cardiovascular Quality and Outcomes. 2022;15(5):e008359.

Uddin I, Khan MI, Younas N, Hashmi MO, Shah S, Mehmood A. Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury. Pakistan Journal of Medical & Health Sciences. 2023;17(01):867-.

Shinwari MI, Khan MI, Hasan T, Khan RM, Ziyad M. Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury in Patient Undergoing Percutaneous Coronary Intervention. Pakistan Journal of Medical & Health Sciences. 2023;17(02):820-.

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Published

2024-09-30

How to Cite

RAZA , M., AKHTAR, B., BABAR, S., MAL, K., & RIZVI, S. (2024). ASSOCIATION OF RADIAL ARTERY ACCESS WITH REDUCED INCIDENCE OF ACUTE KIDNEY INJURY. Biological and Clinical Sciences Research Journal, 2024(1), 1098. https://doi.org/10.54112/bcsrj.v2024i1.1098