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

Catheter Cardiovasc Interv. 2018 Dec 1;92(7):E518-E526. doi: 10.1002/ccd.27903. Epub 2018 Sep 23.


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.

Keywords: acute; angiography; brachial/radial/ulnar; catheterization; coronary; coronary artery disease; percutaneous coronary intervention (PCI); renal disease.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / prevention & control*
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods*
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / methods*
  • Contrast Media / administration & dosage*
  • Contrast Media / adverse effects
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods*
  • Femoral Artery*
  • Humans
  • Incidence
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / methods*
  • Radial Artery*
  • Radiography, Interventional / adverse effects
  • Radiography, Interventional / methods*
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome


  • Contrast Media