title: Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch Hospital Patient Safety Program. This study investigates to what extent high-risk patients are identified and hydrated before contrast administration. Hospital-related and admission-related factors associated with the hydration of high-risk patients are identified.
  
  
  METHODS
  The adherence to the guideline concerning identification and hydration of high-risk patients for CIN was evaluated retrospectively in 4297 patient records between November 2011 and December 2012. A multilevel logistic regression analysis was used to investigate the association between hospital-related and patient-related factors and hydration.
  
  
  RESULTS
  The mean percentage patients with a known estimated Glomerular Filtration Rate before contrast administration was 96.4%. The mean percentage high-risk patients for CIN was 14.6%. The mean percentage high-risk patients hydrated before contrast administration was 68.5% and was constant over time. Differences between individual hospitals explained 19% of the variation in hydration. The estimated Glomerular Filtration Rate value and admission department were statistically significantly associated with the execution of hydration.
  
  
  CONCLUSIONS
  The identification of high-risk patients was almost 100%, but the subsequent step in the prevention of CIN is less performed, as only two third of the high-risk patients were hydrated before contrast administration. Large variation between individual hospitals confirmed the difference in hospitals in correctly applying the guideline for preventing CIN.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, P,o, box 1568, 3500 BN Utrecht, The Netherlands. j.schilp@nivel.nl.
authors.forename: Janneke
authors.initials: J
authors.lastname: Schilp
authors.forename: Carolien
authors.initials: C
authors.lastname: de Blok
authors.forename: Maaike
authors.initials: M
authors.lastname: Langelaan
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000592:standards*; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D003287:Contrast Media