Provider use of preventive strategies for radiocontrast nephropathy in high-risk patients.
OBJECTIVE
Radiocontrast nephropathy (RCN) is a common and costly form of acute renal failure. Current preventative strategies include the use of intravenous (IV) fluids and the discontinuation of nephrotoxic medications at the time of radiocontrast administration. We sought to determine whether providers employ these strategies in high-risk patients to limit the development of RCN.


METHODS
High-risk patients undergoing procedures using radiocontrast media over a 12-month period were identified. Medical records were reviewed for all subjects who developed RCN and a randomly selected 25% of patients without RCN. Patients with a contraindication to IV volume expansion were excluded. Medical records of the remaining patients were reviewed to determine whether IV fluids were administered and whether NSAIDs or COX-2 inhibitors were prescribed at the time of contrast administration.


RESULTS
RCN developed in 8% of patients overall. Of 144 patients eligible for IV volume expansion, 16% failed to receive any IV fluids. When IV fluids were employed, their dose and timing of administration varied significantly by treating specialty and procedure. NSAIDs and COX-2 inhibitors were prescribed to 8% of patients.


CONCLUSIONS
Commonly accepted strategies for the prevention of RCN are underutilized. Quality improvement efforts are needed to increase the use of these two simple prophylactic measures.
Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pa, USA. weisbordsd@msx.upmc.edu
Steven D
SD
Weisbord
Frank J
FJ
Bruns
Melissa I
MI
Saul
Paul M
PM
Palevsky
D058186:Acute Kidney Injury / Q000209:etiology* / Q000517:prevention & control*; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D028761:Withholding Treatment
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003287:Contrast Media; D016861:Cyclooxygenase Inhibitors; D019275:Radiopharmaceuticals