Radial vs femoral access for the prevention of acute kidney injury (AKI) after coronary angiography or intervention: A systematic review and meta-analysis

Objectives: We sought to investigate the impact of radial vs femoral access on the incidence of acute kidney injury (AKI) after coronary angiography or intervention. Background: There is a growing recognition of the importance of access site selection as an adjudicative measure to mitigate the risk of renal impairment for patients with coronary artery disease undergoing angiography with or without percutaneous coronary intervention. Methods: We conducted a systematic review of the literature and meta-analyzed available evidence comparing the rates of AKI with radial vs femoral access in patients undergoing coronary angiography or intervention. Studies reporting the incidence of AKI as a primary or secondary outcome were pooled in fixed- and random-effects meta-analyses and meta-regression techniques were used to account for across-study heterogeneity. Results: Across data pooled from nine studies (n = 32 181), radial access was significantly associated with a reduction in the incidence of AKI (OR 0.57, 95% CI 0.50 to 0.66, P < 0.0001 with fixed-effects model, OR 0.55, 95% CI 0.45 to 0.67, P < 0.0001 with random-effects model) as compared to femoral. In the meta-regression model, the effect size of radial access effect was related to the number of centers in which studies were conducted. Conclusions: Compared with the femoral approach, radial access was associated with a lower incidence of AKI after coronary angiography or intervention, although this benefit was less pronounced in multicenter than in single-center studies.