Lowering the amount of contrast used and encouraging more oral hydration before and after a PCI procedure reduced contrast-induced acute kidney injury by 21 percent, according to a study published online July 29 in Circulation: Cardiovascular Quality and Outcomes.
Ten hospitals, all part of the Northern New England Cardiovascular Disease Study Group, participated in the study between January 2007 and June 2012, with six utilizing a set of quality improvement measures, two benchmark hospitals and two controls. The quality improvement measures included multidisciplinary teams with regular quality improvement coaching, best practices review, improvements that reduced and conserved the amount of contrast used and use of improved hydration techniques before, during and following PCI.
Changes to hydration orders included reducing the length of time patients were under direction to avoid food or water by mouth (NPO) from 12 hours to two to four hours, the use of a fluid bolus before introducing the contrast and providing patients with better education on self-hydration (oral) prior to release.
Jeremiah R. Brown, PhD, of the Geisel School of Medicine in Lebanon, N.H., and colleagues found that in the hospitals that implemented the quality improvement measures, adjusted rates of contrast-induced acute kidney injury were improved by 21 percent for all patients. Patients with baseline estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2 showed a 28 percent rate reduction with the quality improvement intervention. Propensity matched analysis between the intervention hospitals and the benchmark saw a reduction of 32 percent.
Rates of in-hospital mortality and bleeding complications also decreased in the hospitals participating in the quality improvement intervention: Mortality dropped from 0.6 percent to 0.2 percent and bleeding complications decreased from 1.7 percent to 1 percent.
Changes in access procedure may have had an impact on the results as well, as some of the hospitals began adopting radial access PCI starting in 2008. However, the full impact of this procedure was not included in this study.
“In this 6-year study, we demonstrate that simple cost-effective hospital quality improvement interventions can prevent CI-AKI [contrast-induced acute kidney injury] in 1 of 5 patients undergoing nonemergent PCI and in 1 of 4 patients with baseline chronic kidney disease (eGFR<60 mL/min per 1.73 m2),” wrote Brown et al.
While some quality improvements were still being assimilated into the culture of the interventional hospitals, the improvements showed promise through small changes to procedures, Brown et al noted.