Association Between Chronic Kidney Disease and Rates of Transfusion and Progression to End-Stage Renal Disease in Patients Undergoing Transradial Versus Transfemoral Cardiac Catheterization-An Analysis From the Veterans Affairs Clinical Assessment Reporting and Tracking (CART) Program.

Autor: Vora AN; Durham VA Medical Center, Durham, NC a.vora@duke.edu., Stanislawski M; VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO., Grunwald GK; VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO., Plomondon ME; VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO., Rumsfeld JS; VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO., Maddox TM; VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, CO., Vidovich MI; Jesse Brown VA Medical Center, Chicago, IL., Woody W; GV (Sonny) Montgomery Veterans Administration Medical Center, Jackson, MS., Nallamothu BK; Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, University of Michigan Medical Center University of Michigan Cardiovascular Center CVC Cardiovascular Medicine, Ann Arbor, MI., Gurm HS; VA Ann Arbor Healthcare System and Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI., Rao SV; Durham VA Medical Center, Durham, NC.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2017 Apr 18; Vol. 6 (4). Date of Electronic Publication: 2017 Apr 18.
DOI: 10.1161/JAHA.116.004819
Abstrakt: Background: Patients with chronic kidney disease (CKD) are at increased risk for bleeding, transfusion, and dialysis after cardiac catheterization. Whether rates of these complications are increased in this high-risk population undergoing transradial access compared with transfemoral access is unknown.
Methods and Results: From the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking program, we identified 229 108 patients undergoing cardiac catheterization between 2007 and 2014, of which 48 155 (21.0%) had baseline glomerular filtration rate (GFR) between 15 and 59 mL/min. We used multivariable Cox modeling to determine the independent association between transradial access and postprocedure transfusion as well as progression to new dialysis by degree of renal dysfunction. Overall, 35 979 (15.7%) of patients underwent Transradial access. Transradial patients tended to be slightly younger, but, overall, had similar rates of CKD compared to transfemoral patients (24.3% vs 27.1%). Transradial patients had longer fluoroscopy times (7.2 vs 6.0 minutes; P <0.001), but lower contrast use (85.0 vs 100.0 mL; P <0.001). The estimated rate of blood transfusion within 48 hours was lower among transradial patients (0.85% vs 1.01%) as were rates of new dialysis at 1 year (0.58% vs 0.71%). After multivariable adjustment, transradial access was associated with lower rates of progression to dialysis at 1 year overall (hazard ratio [HR], 0.83; 95% CI, 0.70-0.98), with no trend of increased risk for dialysis by degree of CKD compared with transfemoral access. Transradial access was associated with greater reduction in transfusion rates with increasing degree of CKD ( P value for trend=0.04: non-CKD: HR, 0.99; 95% CI, 0.73-1.34; GFR 45-59 mL/min: HR, 0.93; 95% CI, 0.70-1.23; GFR 30-44 mL/min: HR, 0.73; 95% CI, 0.51-1.03; GFR 15-29 mL/min: HR, 0.43; 95% CI, 0.20-0.90).
Conclusions: Among patients undergoing cardiac catheterization in the VA health system, transradial access was associated with lower risk for postprocedure transfusion within 48 hours among patients with more-severe CKD, and with lower risk of progression to end-stage renal disease at 1 year compared with transfemoral access. These data provide additional evidence that transradial access may provide significant benefit in this high-risk population.
(© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
Databáze: MEDLINE
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