Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists.
OBJECTIVE
The goal of the present study was to survey the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists to evaluate contemporary practice patterns with regards to contrast use, acute kidney injury (AKI) risk assessment, and prevention in patients undergoing invasive angiography. We sought to compare the physician responses against guideline statements and evidence-based data from clinical studies.


METHODS
A 20-question online survey based on a modified Likert scale was sent out via email to the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists. The survey questions focused on prophylaxis methods, medication management, risk assessment, contrast agent use, and postprocedure care. A scoring system was developed which examined the individual responses to analyze the 10 questions with the greatest strength of evidence in the literature and guidelines.


RESULTS
The survey was completed by 506 individuals. Selected responses of note included the use of standardized volume expansion protocols: 64.8%, use of iso-osmolar contrast (iodixanol) in the majority of patients at risk of AKI: 55%, and 27% of individuals reported diluting contrast with saline for patients at risk of AKI during coronary angiography. For questions with support from guideline documents, 56.9% of the responses were scored as concordant with evidence-based data. Individuals who reported that the risk of AKI was often or always important in planning angiography for "at risk patients" were more likely to closely monitor renal function (76.7% vs. 40.0%, P = 0.003), obtain nephrology consultation (45.2% vs. 13.3%, P = 0.016) and use iso-osmolar contrast agents (56.0% vs. 26.7%, P = 0.033).


CONCLUSIONS
The majority of cardiologists participating in this survey, reported practice patterns consistent with guideline and evidence-based recommendations. However, over 40% of responses to questions were inconsistent with these recommendations, suggesting continued opportunities for education and quality improvement concerning AKI prevention. © 2016 Wiley Periodicals, Inc.
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Anand
A
Prasad
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Aaron
A
Sohn
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Jonathan
J
Morales
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Ken
K
Williams
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Steven R
SR
Bailey
Department of Medicine, Division of Cardiology, The University of Texas Health Science Center San Antonio, San Antonio, Texas.
Daniel
D
Levin
Baylor University Medical Center, Dallas, Texas.
Peter A
PA
McCullough
Department of Medicine, Division of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, Mount Sinai.
Roxana
R
Mehran
The Society of Cardiovascular Angiography and Interventions, Washington, DC.
Georgina
G
Lopez-Cruz
The Society of Cardiovascular Angiography and Interventions, Washington, DC.
Joel
J
Harder
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000592:standards / Q000639:trends; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000592:standards / Q000639:trends; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000592:standards / Q000639:trends; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors
D003287:Contrast Media
PCI; acute; angiography; complications; coronary; diagnostic catheterization; peripheral/renal; renal disease