Researchers reduce contrast-induced acute kidney injury using quality improvement methods

Researchers have found a way to reduce kidney injury in patients undergoing a procedure with contrast dye, using quality improvement measures.

Currently, 7–15% of these patients who undergo a coronary stent procedure with contrast-dye end up with kidney injury, which can result in death or rapid decline in kidney function leading to temporary or permanent dialysis, according to a study published in the July issue of Circulation Cardiovascular Quality Outcomes journal.

The researchers looked specifically at patients in the cardiology catheterization lab, but they said they believe the methods they developed over a six-year period to prevent kidney injury are generalizable to all of medicine and contrast procedures.

Jeremiah Brown of The Dartmouth Institute for Health Policy & Clinical Practice and his colleagues found that using a quality improvement design and team coaching, they could reduce kidney injury by 20% among all patients and by 30% among patients with pre-existing chronic kidney disease.

Brown and colleagues from 10 medical centers in northern New England used a simple, team-based approach to prevent acute kidney injury in 21, 067 nonemergent patients undergoing percutaneous coronary intervention.

Interventions included getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure), training the doctors to use less contrast in the procedure and creating stops in the system to delay a procedure if that patient had not received enough oral or intravenous fluids before the case.

"Our regional success was really about hospital teams talking and innovating with one another. Instead of competing with one another in similar health care markets, they shared their data, protocols, and ideas resulting in simple, homegrown, easy to do solutions that improved patient safety across the region," Brown said.