This document summarizes several studies on the risk of acute kidney injury following percutaneous coronary intervention (PCI) via the radial versus femoral artery access site. Registry data from British Columbia and a large US study found that femoral access was associated with significantly higher odds of adverse kidney outcomes after adjusting for risk factors. A single-center study also found higher rates of post-PCI acute kidney injury with femoral compared to radial access after propensity matching. While patient characteristics and contrast load are major risk factors for procedure-associated acute kidney injury, available data suggests radial access may have renoprotective effects compared to the femoral approach.

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Acute Kidney Injury
US Prospective
Ian C Gilchrist, MD, FACC, FSCAI
Professor of Medicine
Penn State’s Hershey Medical Center
Heart & Vascular Institute
Hershey, PA

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CME Disclosure Statement
Nothing Relevant to this Presentation

3. A switch to radial is more than a change in
access site, but an opportunity to alter the whole
experience.
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Radial-Renal Interaction?
 Contrast
 Blood Loss
 Exposure to the Aorta
Analysis confounded by  use of transradial in those at highest risk for kidney injury

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Registry Data Report
Vuurmans T et al. Heart 2010;96:1538-1542
PROMIS: Patient Outcome and Management Information System

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BCCR Registry Outcomes
Outcomes:
Dialysis <6 months for all patients,
Estimated glomerular filtration rate (eGFR)
<30 ml/min <6 months for patients with
baseline eGFR>30 ml/min,
New referral to nephrology <6 months for
patients with eGFR>60 ml/min at baseline
Composite end point for adverse renal events.
Vuurmans T et al. Heart 2010;96:1538-1542

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Radial vs Femoral
Renal Outcomes
British Columbia Cardiac and Renal Registries
*p<.0001
Multivariate predictor for adverse renal events:
Femoral access OR 4.36 [2.48 to 7.66], p<.0001
Vuurmans T et al. Heart 2010;96:1538-1542

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Site Specific Data
1637 procedures
April 2009–Sept 2012
Radial 996 Femoral 641
Acute kidney injury defined as:
Serum creatinine >0.5 mg/dl or 50% from baseline within 72 hours of procedure
Propensity matched with multivariable logistic regression adjusting for kidney injury
Damluji, Gilchrist, et al. Int J Cardiol 2014;173(3):595-7.

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Risk Predictors of Post PCI Acute
Kidney Injury
Multivariable logistic regression analysis
Diabetes
Prior CABG
Prior MI
Contrast Volume
Femoral Access
0 1 2 3 4
Odds Ratio & 95% CI
Damluji, Gilchrist, et al. Int J Cardiol 2014;173(3):595-7.

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Large US Registry
Blue Cross Blue Shield of Michigan Cardiovascular Consortium
Jan 2010–Dec 2012
96,753 Procedures
Radial 8,951
Propensity Matched
Cohort 17,716
(8857 each)
Femoral 73,310
14,528 Excluded
(dialysis, missing
creatinine, brachial
access)
Kooiman, et al. Circulation: Cardiovascular Interventions 2014; 7(2):190–198

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Risk of Nephropathy After
Radial vs Femoral PCI
Kooiman, et al. Circulation: Cardiovascular Interventions 2014; 7(2):190–198

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Summary
• Catheterization associated acute kidney injury
is a multifactorial disease
• Underlying patient characteristics & contrast
load play a dominant role
• Multiple non-randomized studies have now
suggested factor(s) modified by the the
decision to go radial may have a protective
effect

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Thank you