Gilchrist IC - AIMRADIAL 2014 - Acute kidney injury
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Acute kidney injury: US perspective
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Gilchrist IC - AIMRADIAL 2014 - Acute kidney injury
- 1. icg 2014 Acute Kidney Injury US Prospective Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Penn State’s Hershey Medical Center Heart & Vascular Institute Hershey, PA
- 2. icg 2014 CME Disclosure Statement Nothing Relevant to this Presentation
- 3. A switch to radial is more than a change in access site, but an opportunity to alter the whole experience. icg 2014
- 4. icg 2014 Radial-Renal Interaction? Contrast Blood Loss Exposure to the Aorta Analysis confounded by use of transradial in those at highest risk for kidney injury
- 5. icg 2014 Registry Data Report Vuurmans T et al. Heart 2010;96:1538-1542 PROMIS: Patient Outcome and Management Information System
- 6. icg 2014 BCCR Registry Outcomes Outcomes: Dialysis <6 months for all patients, Estimated glomerular filtration rate (eGFR) <30 ml/min <6 months for patients with baseline eGFR>30 ml/min, New referral to nephrology <6 months for patients with eGFR>60 ml/min at baseline Composite end point for adverse renal events. Vuurmans T et al. Heart 2010;96:1538-1542
- 7. icg 2014 Radial vs Femoral Renal Outcomes British Columbia Cardiac and Renal Registries *p<.0001 Multivariate predictor for adverse renal events: Femoral access OR 4.36 [2.48 to 7.66], p<.0001 Vuurmans T et al. Heart 2010;96:1538-1542
- 8. icg 2014 Site Specific Data 1637 procedures April 2009–Sept 2012 Radial 996 Femoral 641 Acute kidney injury defined as: Serum creatinine >0.5 mg/dl or 50% from baseline within 72 hours of procedure Propensity matched with multivariable logistic regression adjusting for kidney injury Damluji, Gilchrist, et al. Int J Cardiol 2014;173(3):595-7.
- 9. icg 2014 Risk Predictors of Post PCI Acute Kidney Injury Multivariable logistic regression analysis Diabetes Prior CABG Prior MI Contrast Volume Femoral Access 0 1 2 3 4 Odds Ratio & 95% CI Damluji, Gilchrist, et al. Int J Cardiol 2014;173(3):595-7.
- 10. icg 2014 Large US Registry Blue Cross Blue Shield of Michigan Cardiovascular Consortium Jan 2010–Dec 2012 96,753 Procedures Radial 8,951 Propensity Matched Cohort 17,716 (8857 each) Femoral 73,310 14,528 Excluded (dialysis, missing creatinine, brachial access) Kooiman, et al. Circulation: Cardiovascular Interventions 2014; 7(2):190–198
- 11. icg 2014 Risk of Nephropathy After Radial vs Femoral PCI Kooiman, et al. Circulation: Cardiovascular Interventions 2014; 7(2):190–198
- 12. icg 2014 Summary • Catheterization associated acute kidney injury is a multifactorial disease • Underlying patient characteristics & contrast load play a dominant role • Multiple non-randomized studies have now suggested factor(s) modified by the the decision to go radial may have a protective effect
- 13. icg 2014 Thank you