Abstract 20073: Prevention of Contrast-Induced Acute Kidney Injury: A Mixed Methods Analysis Running Title: Acute Kidney Injury Prevention
Background: Contrast-induced acute kidney injury (AKI) is a recognized as a complication of invasive cardiovascular procedures and is associated with cardiovascular events, prolonged hospitalization, end-stage renal disease, and all-cause mortality. Reducing the risk of CI-AKI is a patient safety objective set by the National Quality Forum. We hypothesized variation in practice patterns are associated with CI-AKI and therefore standardization based on best practices would result in a reduction in CI-AKI.
Methods: We prospectively collected quantitative and qualitative data from 10 centers, which participate in the Northern New England Cardiovascular Disease Study Group PCI Registry. Quantitative data were collected from the PCI registry. Qualitative data were obtained through clinical team meetings to map care processes related to CI-AKI and focus groups to understand attitudes towards CI-AKI prophylaxis.
Results: Five-fold variation in rates of CI-AKI and PCI processes of care were found across ten medical centers (Figure). Four process variables were associated with lower rates of AKI: 1) reducing NPO time to 4 hours prior to case, 2) standardizing hydration protocols, 3) administering 3–4 high doses of N-acetylcysteine (1200 mg) for each patient; and 4) Iopamidol low-osmolar contrast agent.
Conclusions: In conclusion, these data suggest that evidence-based practices can be associated with reduced rates of CI-AKI.
- © 2010 by American Heart Association, Inc.