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: Thomas M. Maddox, Amit Navin Vora, Walter W. Woody, Maggie A. Stanislawski, Mladen I. Vidovich, Brahmajee K. Nallamothu, Sunil V. Rao, Hitinder S. Gurm, John S. Rumsfeld, Mary E. Plomondon, Gary K. Grunwald
Rok vydání: 2017
Předmět:
Male
Cardiac Catheterization
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
radial artery catheter
0302 clinical medicine
Risk Factors
Medicine
030212 general & internal medicine
Original Research
Cardiac catheterization
education.field_of_study
Quality and Outcomes
Middle Aged
Interventional Cardiology
3. Good health
Femoral Artery
United States Department of Veterans Affairs
Treatment Outcome
Radial Artery
Disease Progression
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Population
Veterans Health
Renal function
Hemorrhage
Punctures
blood transfusion
Lower risk
End stage renal disease
03 medical and health sciences
Percutaneous Coronary Intervention
Renal Dialysis
Internal medicine
Humans
Renal Insufficiency
Chronic

education
Veterans Affairs
Dialysis
Aged
Proportional Hazards Models
Retrospective Studies
business.industry
Transfusion Reaction
medicine.disease
United States
Surgery
Multivariate Analysis
Kidney Failure
Chronic

dialysis
business
chronic kidney disease
Kidney disease
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.116.004819
Popis: 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 P 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.
Databáze: OpenAIRE
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