Email updates

Keep up to date with the latest news and content from BMC Nephrology and BioMed Central.

Open Access Highly Accessed Research article

Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy

Janneke Schilp1*, Carolien de Blok1, Maaike Langelaan1, Peter Spreeuwenberg1 and Cordula Wagner12

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, P.o. box 1568, 3500 BN Utrecht, The Netherlands

2 Department of Public and Occupation Health, EMGO + Institute for Health and Care Research, VU University Medical Center (VUmc), Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

For all author emails, please log on.

BMC Nephrology 2014, 15:2  doi:10.1186/1471-2369-15-2

Published: 6 January 2014

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.

Conclusion

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.

Keywords:
Contrast-induced nephropathy; Identification; Hydration; Dutch hospital patient safety program; Guideline adherence; Prevention