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. 2009 Mar;24(3):289-98.
doi: 10.1007/s11606-008-0894-4. Epub 2009 Jan 21.

Factors associated with the use of preventive care for contrast-induced acute kidney injury

Steven D Weisbord  1 , Maria K Mor, Sunghee Kim, Kathryn C Hartwig, Ali F Sonel, Paul M Palevsky, Michael J Fine
Affiliations

Factors associated with the use of preventive care for contrast-induced acute kidney injury

Steven D Weisbord et al. J Gen Intern Med. 2009 Mar.

Abstract

Background: The factors that affect the implementation of preventive care for contrast-induced acute kidney injury (CIAKI) are unknown.

Objective: To assess patient and provider factors associated with the use of preventive care for CIAKI.

Design: Prospective cohort study.

Participants: Patients with kidney disease undergoing procedures with intravascular iodinated radiocontrast.

Measurements: We recorded the use of preventive care defined as the administration of: (1) pre- and post-procedure isotonic intravenous (IV) fluid, (2) N-acetylcysteine, and (3) iso-osmolal radiocontrast. We surveyed patients' providers to assess their knowledge, experience, and training on CIAKI and used multiple logistic regression to assess the independent associations of patient and provider factors with the use of these preventive interventions.

Results: We enrolled 660 patients and 87 providers. Patient factors associated with use of IV fluid and N-acetylcysteine were higher baseline serum creatinine (OR 1.5 and 5.0, p < 0.05) and inpatient status (OR 3.0 and 6.3, p < 0.05), while higher baseline serum creatinine was associated with the use of iso-osmolal contrast (OR = 13.4, p < 0.01). The primary provider characteristics associated with the use of IV fluid and N-acetylcysteine were a greater degree of prior training on CIAKI (OR 1.9 and 2.8, p < 0.05) and higher number of prior patients with CIAKI (OR 2.7 and 2.6, p < 0.05).

Conclusions: Patient baseline kidney function and provider training and experience with CIAKI are independently associated with the use of preventive care. Efforts to increase and intensify the training providers receive on CIAKI may help decrease the incidence of this costly iatrogenic condition.

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Figures

Figure 1
Figure 1
Patient and provider recruitment.
Figure 2
Figure 2
Use of preventive care by procedure type in patients with diabetes mellitus.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJM199411243312111', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejm199411243312111'}, {'type': 'PubMed', 'value': '7969286', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/7969286/'}]}
    2. Barrett BJ, Parfrey PS. Prevention of nephrotoxicity induced by radiocontrast agents. N Engl J Med. 1994;331:1449–50. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1093/ndt/14.5.1146', 'is_inner': False, 'url': 'https://doi.org/10.1093/ndt/14.5.1146'}, {'type': 'PubMed', 'value': '10344353', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10344353/'}]}
    2. Erley CM, Duda SH, Rehfuss D, et al. Prevention of radiocontrast-media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline. Nephrol Dial Transplant. 1999;14:1146–9. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1093/ndt/gfl215', 'is_inner': False, 'url': 'https://doi.org/10.1093/ndt/gfl215'}, {'type': 'PubMed', 'value': '16723348', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16723348/'}]}
    2. Lameire NH. Contrast-induced nephropathy-prevention and risk reduction. Nephrol Dial Transplant. 2006;21:i11–23. - PubMed
    1. Rudnick M, Tumlin J. In: Rose BD, ed. Prevention of radiocontrast media-induced acute kidney injury. Waltham, MA: UpToDate: 2007.
    1. Rudnick M, Tumlin J. In: Rose BD, ed. Pathogenesis, clinical features, and diagnosis of radiocontrast media-induced acute kidney injury (acute renal failure). UpToDate. Waltham, MA: 2007.

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