Measuring the Variation in the Prevention and Treatment of CI-AKI Among Interventional Cardiologists
| Autor: | Czarlota Valdenor, John W. Peabody, Peter A. McCullough, Jeffrey R. Dahlen, David Paculdo, Takeshi Sugaya, Eisei Noiri, M. Czarina Acelajado |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Contrast Media Diagnostic accuracy 030204 cardiovascular system & hematology Nephrotoxicity 03 medical and health sciences chemistry.chemical_compound Cardiologists 0302 clinical medicine Creatinine testing Risk Factors Internal medicine Volume expansion Humans Medicine 030212 general & internal medicine Creatinine business.industry Acute kidney injury General Medicine Acute Kidney Injury medicine.disease chemistry Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | Current Problems in Cardiology. 46:100851 |
| ISSN: | 0146-2806 |
| DOI: | 10.1016/j.cpcardiol.2021.100851 |
| Popis: | Contrast-induced acute kidney injury (CI-AKI) occurs in up to 10% of cardiac catheterizations and coronary interventions, resulting in increased morbidity, mortality, and cost. One main reason for these complications and costs is under-recognition of CI-AKI risk and under-treatment of patients with impaired renal status. 157 interventional cardiologists each cared for three simulated patients with common conditions requiring intravascular contrast media in three typical settings: pre-procedurally, during the procedure, and post-procedure. We evaluated their ability to assess the risk of developing CI-AKI, make the diagnosis, and treat CI-AKI, including proper volume expansion and withholding nephrotoxic medications. Overall, the quality-of-care scores averaged 46.0% ± 10.5, varying between 18% to 78%. The diagnostic scores for accurately assessing risk of CI-AKI were low at 57.1% ± 21.2% and the accuracy of diagnosis pre-existing chronic kidney disease was 50.2%. Poor diagnostic accuracy led to poor treatment: proper volume expansion done in only 30.7% of cases, in-hospital repeat creatinine evaluation performed in 32.1%, and avoiding nephrotoxic medications occurred in 14.2%. While volume expansion was relatively similar across the three settings (P = 0.287), the cardiologists were less likely to discontinue nephrotoxic medications in pre-procedurally (9.7%) compared to the other settings (27.0%), and to order in-hospital creatinine testing in peri-procedurally (18.8%) compared to post-procedure (57.8%) (P0.05 for both). The overall care of patients at risk for contrast-induced acute kidney injury varied widely and showed room for improvement. Improving care for this condition will require greater awareness by cardiologists and better diagnostic tools to guide them. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect