Acute Care/Hospitalization

Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease

Patients with cardiovascular disease frequently have radiographic procedures involving the use of infused radio-contrast agents. In 3-14 percent of patients, the use of these agents is associated with contrast-induced acute kidney injury (CI-AKI). Radio contrast has been hypothesized to cause AKI through direct toxicity and via hemodynamic changes. A new study has identified ways to reduce CI-AKI in patients with cardiovascular disease. When researchers looked at 10 Northern New England medical centers, they found a fivefold variation in the rates of CI-AKI. Centers with lower rates of CI-AKI were those with strong clinical leadership and aggressive prophylaxis through volume expansion with fluids prior to the procedure.

For example, centers with lower rates of CI-AKI were more likely to bypass the nothing by mouth after midnight in favor of nothing by mouth 4 hours prior to the radiographic procedure and standardizing volume administration protocols in combination with administering three to four high doses of N-acetylcysteine (1200 mg) for each patient.

This study is part of an effort by the Northern New England Cardiovascular Disease Study Group to evaluate the relationship of high-intensity quality improvement efforts on patient safety and CI-AKI. Their next step is to start a high-intensity quality improvement intervention. This study was supported in part by the Agency for Healthcare Research and Quality (HS19443).

See "How do centres begin the process to prevent contrast-induced acute kidney injury: A report from a new regional collaborative," by Jeremiah R. Brown, M.D., Peter A. McCullough, M.D., Mark E. Splaine, M.D., and others in the BMJ Journal of Quality and Safety 21, pp. 54-62, 2012.

— MWS

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