Objective: Cardiac catheterization using the distal radial artery access (DRA), at the level of the anatomical snuff box post radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery access (PRA) in cardiac catheterization or angiography. Methods: A detailed literature search was performed on PubMed, Cochrane, Embase and Clinicaltrials.gov from inception till June 2024. Risk ratios (RR) and mean differences (MD) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on Revman. Results: Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-hour radial artery occlusion (RAO) rates (RR 0.30, 95% CI 0.23 to 0.40, p ≤ 0.00001), and time to hemostasis (minutes) (MD -44.46, 95% CI -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI 2.02 to 4.15, p < 0.00001, and puncture attempts (MD 0.69, 95% CI 0.37 to 1.00, p = 0.00001). Conclusion: DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.

Objective: Cardiac catheterization using the distal radial artery access (DRA), at the level of the anatomical snuff box post radial artery bifurcation, may be linked to a lower rate of arterial occlusion and better hemostasis. In this meta-analysis, we compare DRA versus proximal radial artery access (PRA) in cardiac catheterization or angiography. Methods: A detailed literature search was performed on PubMed, Cochrane, Embase and Clinicaltrials.gov from inception till June 2024. Risk ratios (RR) and mean differences (MD) were pooled for categorical and continuous outcomes, respectively. Random effects meta-analysis was undertaken on Revman. Results: Our meta-analyses include 21 randomized controlled trials with 9,539 patients (DRA 4,761, PRA 4,778). DRA significantly reduced 24-hour radial artery occlusion (RAO) rates (RR 0.30, 95% CI 0.23 to 0.40, p ≤ 0.00001), and time to hemostasis (minutes) (MD -44.46, 95% CI -50.64 to -38.92, p < 0.00001), whereas PRA was significantly superior in terms of the puncture success rate (RR 0.96, 95% CI 0.93 to 0.99, p < 0.01), the crossover rate (RR 2.89, 95% CI 2.02 to 4.15, p < 0.00001, and puncture attempts (MD 0.69, 95% CI 0.37 to 1.00, p = 0.00001). Conclusion: DRA was associated with a lower risk of occlusion and lower time to hemostasis, but required a greater number of puncture attempts and had lower success rate. Further research is required to elucidate the most optimal approach.

Background: Tenapanor is currently seen as a promising treatment for hyperphosphatemia in haemodialysis patients. Although previous meta-analysis has investigated its efficacy and safety, the potential impact of tenapanor remained a topic of further investigation. This meta-analysis aims to provide an updated and thorough assessment of tenapanor efficacy in reducing serum phosphate levels and its safety in haemodialysis patients, integrating new evidence and refining the analysis of treatment outcomes. Methodology:In this systematic review and meta-analysis, we searched online databases up to August 2024 for studies evaluating the efficacy and safety of tenapanor in haemodialysis patients. Only short-term randomized controlled trials (4 to 8 weeks) comparing tenapanor with placebo were included. The primary outcome was the change in serum phosphate levels from baseline. Safety was assessed based on data regarding drug-related adverse effects (AEs), including diarrhoea and other gastrointestinal AEs. Results:Among the selected 8 clinical trails with a total of 1001 patients, tenapanor showed a significant reduction in serum phosphate levels from baseline compared to placebo (mean difference [MD] -1.39mg/dl, 95% CI: -1.94,0.84, p <0.0001). Greater number of patients in the tenapanor group were able to achieve target serum phosphate levels of ≦5.5 mg/dl (relative risk [RR] 2.80; 95% CI: 1.70, 4.61; p < 0.0001). Drug related AEs, gastrointestinal AEs and diarrhoea was more severe in tenapanor group compared to placebo.Conclusion:In summary, the results indicate that tenapanor effectively lowers serum phosphate levels in haemodialysis patients and facilitates achievement of target levels, although drug-related side effects were common. However, these findings are based exclusively on short-term trials (4-8 weeks). Further long-term studies are needed to confirm the sustained efficacy and safety of tenapanor.

Background: Tenapanor is currently seen as a promising treatment for hyperphosphatemia in haemodialysis patients. Although previous meta-analysis has investigated its efficacy and safety, the potential impact of tenapanor remained a topic of further investigation. This meta-analysis aims to provide an updated and thorough assessment of tenapanor efficacy in reducing serum phosphate levels and its safety in haemodialysis patients, integrating new evidence and refining the analysis of treatment outcomes. Methodology:In this systematic review and meta-analysis, we searched online databases up to August 2024 for studies evaluating the efficacy and safety of tenapanor in haemodialysis patients. Only short-term randomized controlled trials (4 to 8 weeks) comparing tenapanor with placebo were included. The primary outcome was the change in serum phosphate levels from baseline. Safety was assessed based on data regarding drug-related adverse effects (AEs), including diarrhoea and other gastrointestinal AEs. Results:Among the selected 8 clinical trails with a total of 1001 patients, tenapanor showed a significant reduction in serum phosphate levels from baseline compared to placebo (mean difference [MD] -1.39mg/dl, 95% CI: -1.94,0.84, p <0.0001). Greater number of patients in the tenapanor group were able to achieve target serum phosphate levels of ≦5.5 mg/dl (relative risk [RR] 2.80; 95% CI: 1.70, 4.61; p < 0.0001). Drug related AEs, gastrointestinal AEs and diarrhoea was more severe in tenapanor group compared to placebo.Conclusion:In summary, the results indicate that tenapanor effectively lowers serum phosphate levels in haemodialysis patients and facilitates achievement of target levels, although drug-related side effects were common. However, these findings are based exclusively on short-term trials (4-8 weeks). Further long-term studies are needed to confirm the sustained efficacy and safety of tenapanor.