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Transradial Percutaneous Coronary Intervention in Patients With Advanced Chronic Kidney Disease

Fumiaki Yashima1, Taku Inohara2, Yohei Numasawa3

  • 1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|February 25, 2020
PubMed

Insights

Transradial intervention (TRI) may reduce acute kidney injury and the need for hemodialysis in percutaneous coronary intervention (PCI) patients with advanced chronic kidney disease (CKD). Further research is needed to confirm TRI benefits in this population.

Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Transradial intervention (TRI) generally shows better outcomes than transfemoral intervention (TFI) in percutaneous coronary intervention (PCI).
  • Patients with advanced chronic kidney disease (CKD) face higher risks of complications and TRI is often avoided due to potential impact on arteriovenous fistula creation for hemodialysis.
  • Limited data exists on the safety and efficacy of TRI specifically in advanced CKD patients undergoing PCI.

Purpose of the Study:

  • To assess the impact and outcomes of transradial intervention (TRI) compared to transfemoral intervention (TFI) in patients with advanced chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).

Main Methods:

  • Analysis of consecutive PCI patients with advanced CKD (eGFR <30 mL/min/1.73 m²).
  • Comparison of periprocedural bleeding, acute kidney injury (AKI), and need for hemodialysis initiation between TRI and TFI groups.
  • 1:1 propensity score matching was used to control for baseline differences between the TRI and TFI groups.

Main Results:

  • After propensity matching, TRI was associated with significantly reduced risks of periprocedural acute kidney injury (AKI) (12.4% vs. 26.5%) and hemodialysis initiation (3.1% vs. 12.4%) compared to TFI.
  • TRI showed a trend towards lower rates of bleeding complications, though not statistically significant (1.9% vs. 6.2%).
  • The study included 324 patients (mean age 74.9 years, 63.6% male) after matching.

Conclusions:

  • Transradial intervention (TRI) may offer benefits over transfemoral intervention (TFI) in percutaneous coronary intervention (PCI) patients with advanced chronic kidney disease (CKD).
  • TRI appears to reduce the risk of acute kidney injury and the need for subsequent hemodialysis in this vulnerable patient group.
Abstract

Keywords:
Acute kidney injuryBleedingCKDTRI

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