Post procedure bleeding and blood transfusion are independently associated with the development of AKI. The other mechanism by which TRA leads to less kidney injury is through a reduced risk of bleeding and the subsequent need for a blood transfusion. The primary mechanism by which TRA was associated with a lower risk of kidney injury is thought to be through a reduced likelihood of renal atheroembolization because it offers the additional advantage of avoiding passage through potential atheromatous aortae and renal vessels. Finally, a recent meta-analysis of observational studies (adjusted by propensity score matching) showed that TRA, compared to TFA, was associated with lower risk of AKI. Similarly, another propensity-matched study showed that TRA, compared to TFA, was associated with a lower risk of AKI.

In contrast, a report from the British Columbia Cardiac and Renal Registries that included 69214 patients after coronary catheterization and PCI showed that chronic kidney disease (CKD) onset within 6 mo was significantly lower with TRA compared to TFA (0.5% vs 2.2%, P < 0.001) even after adjusting for baseline variables. Although there have been reports of greater contrast use with TRA and concerns about possible subsequent CIN from this more extensive dye load, our meta-analysis shows that the volume of contrast used is not higher among patients undergoing PCI with TRA compared to TFA. Among these, contrast volume is a well-established, dose-dependent, and potentially modifiable risk factor for CIN. The reported incidence of CIN post-PCI varies widely depending on numerous clinical, demographic, and procedural factors. The two major causes of post-PCI AKI are contrast-induced nephropathy (CIN) and renal atheroembolus. However, most trials were single-centered, and the majority of procedures were performed by radial experts.ДЄcute kidney injury (AKI) is a well-recognized complication of PCI that is associated with greater risk of in-hospital mortality and poor long-term outcomes. Overall, there was no difference in contrast volume use between the two access strategies. In this study, we compared a broad spectrum of 3165 patients enrolled in 13 RCTs in terms of the contrast volume used during TRA or TFA during PCI. Finally, an additional sensitivity analysis was performed where one study at a time was excluded, and the impact on the summary results of removing each was evaluated. The measure of I 2 can be interpreted as the percentage of variability resulting from heterogeneity between studies rather than sampling error.

The presence of heterogeneity across trials was evaluated using the Cochran Q test and the Higgins I 2 test. A random-effects model was used to analyze data. We summarized the data as the weighted mean difference (WMD) of contrast used with a 95%CI using Comprehensive Meta-Analysis (CMA) system version 3 (Comprehensive Meta-Analysis Biostat Inc., Englewood, NJ, United States). We were able to obtain the mean contrast used for only one additional trial. We also contacted corresponding authors for those articles not reporting contrast volume or reporting the median contrast used.

Trials were included if they enrolled patients undergoing PCI and randomly assigned them to TRA or TFA.

Data were collected by two independent investigators, and disagreements were resolved by consensus. We performed a systematic search of PubMed, Embase, and the Cochrane Library and cross-referenced relevant articles using various combinations of keywords such as вЂњradialвЂќ, вЂњfemoralвЂќ, вЂњcardiac catheterizationвЂќ, and вЂњcoronary interventionвЂќ for eligible published studies. This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses.

We used comprehensive meta analysis for