Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy

Janneke Schilp, Carolien de Blok, Maaike Langelaan, Peter Spreeuwenberg, Cordula Wagner, Janneke Schilp, Carolien de Blok, Maaike Langelaan, Peter Spreeuwenberg, Cordula Wagner

Abstract

Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch Hospital Patient Safety Program. This study investigates to what extent high-risk patients are identified and hydrated before contrast administration. Hospital-related and admission-related factors associated with the hydration of high-risk patients are identified.

Methods: The adherence to the guideline concerning identification and hydration of high-risk patients for CIN was evaluated retrospectively in 4297 patient records between November 2011 and December 2012. A multilevel logistic regression analysis was used to investigate the association between hospital-related and patient-related factors and hydration.

Results: The mean percentage patients with a known estimated Glomerular Filtration Rate before contrast administration was 96.4%. The mean percentage high-risk patients for CIN was 14.6%. The mean percentage high-risk patients hydrated before contrast administration was 68.5% and was constant over time. Differences between individual hospitals explained 19% of the variation in hydration. The estimated Glomerular Filtration Rate value and admission department were statistically significantly associated with the execution of hydration.

Conclusion: The identification of high-risk patients was almost 100%, but the subsequent step in the prevention of CIN is less performed, as only two third of the high-risk patients were hydrated before contrast administration. Large variation between individual hospitals confirmed the difference in hospitals in correctly applying the guideline for preventing CIN.

Figures

Figure 1
Figure 1
Trend of percentage hydrated high-risk patients (n = 581).

References

    1. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–1399.
    1. Lasser EC, Lyon SG, Berry CC. Reports on contrast media reactions: analysis of data from reports to the U.S. Food and drug administration. Radiology. 1997;203:605–610.
    1. Chong E, Shen L, Poh KK, Tan HC. Risk scoring system for prediction of contrast-induced nephropathy in patients with pre-existing renal impairment undergoing percutaneous coronary intervention. Singapore Med J. 2012;53:164–169.
    1. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006. pp. S11–S15.
    1. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:1419–1428. doi: 10.1016/j.jacc.2007.12.035.
    1. Bagshaw SM, Culleton BF. Contrast-induced nephropathy: epidemiology and prevention. Minerva Cardioangiol. 2006;54:109–129.
    1. Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, Lansky AJ, Moussa I, Stone GW, Moses JW, Leon MB, Mehran R. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95:13–19. doi: 10.1016/j.amjcard.2004.08.056.
    1. Li JH, He NS. Prevention of iodinated contrast-induced nephropathy. Chin Med J (Engl) 2011;124:4079–4082.
    1. Navaneethan SD, Singh S, Appasamy S, Wing RE, Sehgal AR. Sodium bicarbonate therapy for prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Am J Kidney Dis. 2009;53:617–627. doi: 10.1053/j.ajkd.2008.08.033.
    1. Bader BD, Berger ED, Heede MB, Silberbaur I, Duda S, Risler T, Erley CM. What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? Clin Nephrol. 2004;62:1–7. doi: 10.5414/CNP62001.
    1. Chen SL, Zhang J, Yei F, Zhu Z, Liu Z, Lin S, Chu J, Yan J, Zhang R, Kwan TW. Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol. 2008;126:407–413. doi: 10.1016/j.ijcard.2007.05.004.
    1. Krasuski RA, Beard BM, Geoghagan JD, Thompson CM, Guidera SA. Optimal timing of hydration to erase contrast-associated nephropathy: the OTHER CAN study. J Invasive Cardiol. 2003;15:699–702.
    1. Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, Marsch S, Roskamm H. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162:329–336. doi: 10.1001/archinte.162.3.329.
    1. Taylor AJ, Hotchkiss D, Morse RW, McCabe J. PREPARED: preparation for angiography in renal dysfunction: a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction. Chest. 1998;114:1570–1574. doi: 10.1378/chest.114.6.1570.
    1. Trivedi HS, Moore H, Nasr S, Aggarwal K, Agrawal A, Goel P, Hewett J. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract. 2003;93:C29–C34. doi: 10.1159/000066641.
    1. VMS Safety Program. .
    1. Dutch Institute for Healthcare Improvement CBO. Richtlijn Voorzorgsmaatregelen bij jodiumhoudende contrastmiddelen (in English: Guideline preventing methods with contrast medium administration) Utrecht, The Netherlands; 2007.
    1. VMS. Prevention of contrast-induced renal failure. Utrecht, The Netherlands: VMS Zorg; 2009.
    1. Conroy M, Shannon W. Clinical guidelines: their implementation in general practice. Br J Gen Pract. 1995;45:371–375.
    1. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–1322. doi: 10.1016/0140-6736(93)92244-N.
    1. McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, Tumlin J. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98:27K–36K.
    1. Toprak O. Conflicting and new risk factors for contrast induced nephropathy. J Urol. 2007;178:2277–2283. doi: 10.1016/j.juro.2007.08.054.
    1. De Blok C, Koster E, Schilp J, Wagner C. Implementation VMS safety program, evaluation study in dutch hospitals (in dutch: implementatie VMS veiligheidsprogramma, evaluatieonderzoek in nederlandse ziekenhuizen) Utrecht/Amsterdam, The Netherlands: NIVEL/EMGO+; 2013. English summary on .
    1. Twisk JW. Applied multilevel analysis: a practical guide. Cambridge: Cambridge University Press; 2006.
    1. Calabro P, Bianchi R, Crisci M, Caprile M, Bigazzi MC, Palmieri R, Golia E, De VA, Romano IJ, Limongelli G, Russo MG, Calabro R. Use and efficacy of saline hydration and N-acetyl cysteine to prevent contrast-induced nephropathy in low-risk populations undergoing coronary artery angiography. Intern Emerg Med. 2011;6:503–507. doi: 10.1007/s11739-011-0513-y.
    1. Kooiman J, Van der Molen AJ, Cannegieter SZ, Rabelink TJ. Prevention of contrast-induced nephropathy, time for nuance and a new guideline (in Dutch: Preventie van contrastnefropathie, tijd voor nuance en een nieuwe richtlijn) Ned Tijdschr Geneesk. 2013;157(12):A5475.

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