How do centres begin the process to prevent contrast-induced acute kidney injury: a report from a new regional collaborative.
How do centres begin the process to prevent contrast-induced acute kidney injury: a report from a new regional collaborative.
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DOI：
10.1136/bmjqs-2011-000041
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发表时间：
2012-01
影响因子：
5.4
通讯作者：
Northern New England Cardiovascular Disease Study Group
中科院分区：
文献类型：
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作者：
Brown JR;McCullough PA;Splaine ME;Davies L;Ross CS;Dauerman HL;Robb JF;Boss R;Goldberg DJ;Fedele FA;Kellett MA;Phillips WJ;Ver Lee PN;Nelson EC;MacKenzie TA;O'Connor GT;Sarnak MJ;Malenka DJ;Northern New England Cardiovascular Disease Study Group
This study evaluates the variation in practice patterns associated with contrast-induced acute kidney injury (CI-AKI) and identifies clinical practices that have been associated with a reduction in CI-AKI. 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 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. Fixed and random effects modeling were conducted to test the differences across centers. Significant variation in rates of CI-AKI were found across ten medical centers. Both fixed effects and mixed effects logistic regression demonstrated significant variabiltiy across centers even after adjustment for baseline co-variates (p<0.001 for both modeling approaches). We found patterns in reported processes and clinical leadership that were attributable to centers with lower rates of CI-AKI. These included: reducing NPO time to 4 hours prior to case, and standardizing volume administration protocols in combination with administering 3–4 high doses of N-acetylcysteine (1200 mg) for each patient. These data suggest that clinical leadership and institution-focused efforts to standardize preventive practices can help reduce the incidence of CI-AKI.
