Interventions Prevent Contrast-Induced Acute Kidney Injury
Quality improvements protect patients undergoing percutaneous coronary intervention.
A quality improvement program helps prevent contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention, according to research published online in Circulation: Cardiovascular Quality and Outcomes.
Jeremiah R. Brown, Ph.D., of the Geisel School of Medicine in Lebanon, N.H., and colleagues compared the rates of CI-AKI after nonemergent percutaneous coronary intervention among 21,067 patients. Patients were receiving care in six hospitals participating in the quality improvement intervention and two hospitals not participating in the intervention.
The researchers found that, in hospitals receiving the intervention, adjusted rates of CI-AKI were 21 percent lower for all patients (risk ratio, 0.79; 95 percent confidence interval, 0.67 to 0.93; P = 0.005) and 28 percent lower for patients with baseline estimated glomerular filtration rate <60 mL/min per 1.73 m² (risk ratio, 0.72; 95 percent confidence interval, 0.56 to 0.91; P = 0.007).
No significant changes in the rates of CI-AKI were observed in hospitals that did not receive the intervention. Key factors associated with quality improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.
"In summary, to our knowledge, this research is the first multicentered approach to preventing CI-AKI using simple quality improvement implementation techniques," the authors write.