Distal Radial Access in Patients With Chronic Kidney Disease: Lessons From the KODRA Registry

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND AND OBJECTIVES: Distal radial artery (DRA) access offers favorable safety compared with conventional transradial access, but evidence in patients with chronic kidney disease (CKD) remains limited. This study evaluated the safety and feasibility of DRA in patients with CKD. METHODS: This post-hoc analysis of the prospective, multicenter KODRA registry included 4,817 patients with available estimated glomerular filtration rate data. The primary endpoint was radial artery occlusion (RAO) before hospital discharge. Secondary endpoints included RAO at 1-month follow-up, distal radial artery occlusion (DRAO), DRA-related bleeding, and procedural success. RESULTS: CKD was present in 901 patients (18.7%). RAO before hospital discharge was more frequent in the CKD group (0.5% vs. 0.1%, p=0.023), whereas RAO at 1-month follow-up was comparable (0.5% vs. 0.8%, p=0.410). DRAO before hospital discharge was also more frequent in the CKD group (1.2% vs. 0.2%, p<0.001) and remained significant after IPTW adjustment. Although DRA-related bleeding was more common in the CKD group (5.1% vs. 3.0%, p=0.002), all events were minor (Bleeding Academic Research Consortium type 1 or 2) and CKD was not independently associated with bleeding after adjustment. In an exploratory parsimonious model, CKD was associated with RAO before hospital discharge (odds ratio, 16.028; 95% confidence interval, 4.035-63.861). Puncture success and procedural success were similarly high in both groups. CONCLUSIONS: In this large prospective registry, DRA was safe and feasible in patients with CKD. Although CKD was associated with early RAO and DRAO in exploratory analyses, these differences did not persist at 1-month follow-up, and CKD was not independently associated with DRA-related bleeding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04080700.