Transradial PCI may lower risk of acute kidney injury

To prevent acute kidney injury (AKI) in patients undergoing PCI, physicians may want to select a transradial (TRI) approach rather than a transfemoral (TFI) approach. A study published online Feb. 25 in Circulation: Cardiovascular Interventions found an association between radial PCI and a lower risk of AKI compared with the femoral approach.

Judith Kooiman, MSc, of the University of Michigan in Ann Arbor, and colleagues used data from the Blue Cross Blue Shield of Michigan cardiovascular consortium, a registry of patients undergoing PCI, and enrolled consecutive patients who had the procedure between 2010 and 2012. They compared the risks of AKI and nephropathy requiring dialysis (NRD) between TRI and TFI patients. The primary endpoint was AKI, defined as an increase in creatinine of 0.5 mg/dL or higher. They also evaluated the risk of nephropathy requiring dialysis and postprocedural bleeding.

Of the 82,225 PCI procedures performed, 8,915 were TRI. After multivariate adjustment, the investigators found TRI associated with a reduced risk of AKI (odds ratio [OR] 0.76) and bleeding as well as a trend toward lower NRD risk. In the propensity-matched population, there were 8,857 procedures per group and TRI was associated with a lower risk of AKI (adjusted OR 0.74) and bleeding (adjusted OR 0.47), but there was no difference in NRD risk.

Data also suggested that although there was an association between bleeding and AKI, a lower risk of bleeding with TRI did not mediate the lower risk in these patients.

Based on a sensitivity analysis, the investigators found the association between TRI and AKI may be due to a fairly strong confounder not measured in the study. They also noted that the observational nature of their research and the use of nonstandard contrast media and AKI preventive treatments were also study limitations.

“Although these data suggest an additional clinical advantage of TRI, this finding needs to be explored in randomized controlled trials,” they wrote.