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 |
Externí odkaz: |
Pro tento záznam nejsou dostupné žádné jednotky.