Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease
Research Activities, August 2012, No. 384
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.