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


METHODS
Prospective cohort study.


METHODS
Patients with kidney disease undergoing procedures with intravascular iodinated radiocontrast.


METHODS
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.
Weisbord
Steven D
SD
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. weisbordsd@upmc.edu
Mor
Maria K
MK
Kim
Sunghee
S
Hartwig
Kathryn C
KC
Sonel
Ali F
AF
Palevsky
Paul M
PM
Fine
Michael J
MJ
D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000792:Angiography / Q000009:adverse effects; D002983:Clinical Competence; D003287:Contrast Media / Q000009:adverse effects*; D003625:Data Collection; D005260:Female; D005919:Glomerular Filtration Rate; D006787:Hospitals, Veterans; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007396:Internship and Residency; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
D003287:Contrast Media; D007552:Isotonic Solutions; D000111:Acetylcysteine