Risk of acute kidney injury in elective percutaneous coronary intervention: A comparative study of radial and femoral access

Abstract

The impact of vascular access type, specifically transradial versus transfemoral, on the occurrence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain. In this study, we aimed to compare the incidence of AKI between the two access groups. Methods. This prospective observational study involved 164 adult patients undergoing elective PCI. Patients were categorized into transfemoral (n = 100) and transradial (n = 64) groups. Demographic data, including age, sex, body surface area, and preoperative glomerular filtration rate, as well as clinical information such as the presence of baseline ventricular dysfunction, diabetes mellitus, hypertension, postoperative blood loss, and transfusion volume, were recorded. Serum creatinine levels within the first 48-72 hours postoperatively were also documented. Results. Out of 100 patients in the transfemoral group, 12 (12%) developed AKI compared with 2 patients out of 64 (3.13%) in the transradial group. In the logistic multivariate analysis, several independent risk factors for AKI in patients undergoing PCI were identified. These factors included age >55 years (OR 2.88, 95% CI 1.09; 11.97, p = 0.046), diabetes (OR 4.82, 95% CI 1.12; 31.65, p = 0.039), preprocedural creatinine levels > 0.85 mg/dL (OR 3.17, 95% CI 1.54; 17.96, p = 0.019), fluoroscopy time > 10 min (OR 6.55, 95% CI 1.65; 26.03, p = 0.008), Mehran score indicating a risk of contrast-induced nephropathy >8 (OR 4.23, 95% CI 1.25; 14.3, p = 0.020), and transfemoral access (OR 3.22, 95% CI 1.08; 18.54, p = 0.044). Conclusions. Transradial access is associated with a significant independent reduction in the incidence of post-PCI AKI compared with transfemoral access. Age >55 years, diabetes, preprocedural creatinine > 0.85 mg/dL, fluoroscopy time > 10 min, Mehran score >8, and transfemoral access were identified as independent risk factors for AKI in patients undergoing PCI.