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

BMC Nephrology

Cordula Wagner¹  Peter Spreeuwenberg²  Maaike Langelaan²  Carolien de Blok²  Janneke Schilp² 

[1] Department of Public and Occupation Health, EMGO + Institute for Health and Care Research, VU University Medical Center (VUmc), Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;NIVEL, Netherlands Institute for Health Services Research, P.o. box 1568, 3500 BN Utrecht, The Netherlands

关键词: Prevention;    Guideline adherence;    Dutch hospital patient safety program;    Hydration;    Identification;    Contrast-induced nephropathy;   

Others  :  1082756
DOI  :  10.1186/1471-2369-15-2

 received in 2013-07-31, accepted in 2014-01-02,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Schilp et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [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.
• [2]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.
• [3]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.
• [4]Mehran R, Nikolsky E: Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl 2006, (100):S11-S15.
• [5]McCullough PA: Contrast-induced acute kidney injury. J Am Coll Cardiol 2008, 51:1419-1428.
• [6]Bagshaw SM, Culleton BF: Contrast-induced nephropathy: epidemiology and prevention. Minerva Cardioangiol 2006, 54:109-129.
• [7]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.
• [8]Li JH, He NS: Prevention of iodinated contrast-induced nephropathy. Chin Med J (Engl) 2011, 124:4079-4082.
• [9]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.
• [10]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.
• [11]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.
• [12]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.
• [13]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.
• [14]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.
• [15]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.
• [16]VMS Safety Programhttp://www.vmszorg.nl webcite
• [17]Dutch Institute for Healthcare Improvement CBO: Richtlijn Voorzorgsmaatregelen bij jodiumhoudende contrastmiddelen (in English: Guideline preventing methods with contrast medium administration). Utrecht, The Netherlands; 2007.
• [18]VMS: Prevention of contrast-induced renal failure. Utrecht, The Netherlands: VMS Zorg; 2009.
• [19]Conroy M, Shannon W: Clinical guidelines: their implementation in general practice. Br J Gen Pract 1995, 45:371-375.
• [20]Grimshaw JM, Russell IT: Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993, 342:1317-1322.
• [21]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.
• [22]Toprak O: Conflicting and new risk factors for contrast induced nephropathy. J Urol 2007, 178:2277-2283.
• [23]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 http://www.nivel.nl webcite
• [24]Twisk JW: Applied multilevel analysis: a practical guide. Cambridge: Cambridge University Press; 2006.
• [25]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.
• [26]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.