title: Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia Cardiac and Renal Registries).
abstract: BACKGROUND
  Acute kidney injury (AKI) is a well-recognised complication of cardiac catheterisation and percutaneous coronary intervention (PCI). However, the incidence of chronic kidney disease (CKD) after catheterisation and PCI has not been fully evaluated. A number of risk factors have been implicated in the development of AKI following cardiac catheterisation. Transradial access could lead to a lower incidence of CKD after catheterisation or PCI because of less catheter contact with aortic atheroma, and reduced potential for atheroembolism.
  
  
  OBJECTIVE
  To determine the incidence of CKD onset and its association with arterial access in patients after cardiac catheterisation or PCI.
  
  
  RESULTS
  Linkages between the British Columbia (BC) Cardiac Registry (N=69 214) patients who underwent catheterisation or PCI between 1999 and 2005 and the BC Renal Database were determined. Within 6 months after the cardiac procedure 0.4% of patients developed dialysis dependency, 0.2% in the transradial versus 0.4% in the transfemoral group (p<0.0001); 0.3% of patients developed stage 4 or 5 CKD, 0.1% in the transradial versus 0.4% in the transfemoral group (p<0.0001); 0.9% of patients developed new CKD, 0.2% in the transradial versus 1.2% in the transfemoral group (p<0.0001). After adjusting for baseline characteristics the femoral access site had an OR of 4.36 (95% CI 2.48 to 7.66) for the development of the composite end point of new dialysis, new stage 4 or 5 CKD or new CKD.
  
  
  CONCLUSIONS
  In this large database of current practice coronary catheterisation and PCI, the incidence of CKD onset within 6 months of the procedure was 0.9%. The transradial access site is associated with less CKD than the femoral approach.
authors.affiliation: Division of Interventional Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada. tvuurmans@vhif.org
authors.forename: Tycho
authors.initials: T
authors.lastname: Vuurmans
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.forename: Eric
authors.initials: E
authors.lastname: Fretz
authors.forename: Christian
authors.initials: C
authors.lastname: Janssen
authors.forename: J David
authors.initials: JD
authors.lastname: Hilton
authors.forename: W Peter
authors.initials: WP
authors.lastname: Klinke
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D012042:Registries; D012307:Risk Factors