The radial artery is a safe and feasible access site to perform cardiac catheterization and percutaneous coronary intervention (PCI) in stable and unstable settings. Recent evidence suggests potential nephroprotective benefits of the radial approach over the femoral route toward both short- and long-term kidney injury preventions. Acute kidney injury (AKI) after cardiac catheterization remains a major issue in hospitalized patients and is associated with worse clinical outcomes. Patients with chronic kidney disease (CKD) are more prone to AKI after cardiac catheterization, requiring careful management to prevent further decline in renal function. The transradial approach (TRA) provides several advantages for renal safety compared to the transfemoral approach (TFA) which include less access site-related bleeding and the avoidance of manipulation of the atheromatous aorta, thus limiting renal atheroembolic events. On the other hand, the extensive use of TRA in patients with advanced CKD has been questioned, raising concerns about the use of previously cannulated radial arteries for the creation of future autogenous radial-cephalic fistulae for hemodialysis access. Several studies have reported conflicting data regarding the use of contrast-associated AKI with TRA, possibly counterbalancing the potential benefits of this approach. In this chapter, we discuss benefits and limits of the transradial strategy in patients undergoing cardiac catheterization, with emphasis on patients with CKD and data on renal safety with this approach.
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