Sluiten Toegevoegd aan Mijn programma.
Sluiten Verwijderd uit Mijn programma.
Terug Home

NIV Congres

donderdag 25 april 2013 17:00 - 18:00

22 Implementation of the VMS theme 'prevention of contrast-induced nephropathy': incidence, reversibility and risk factors

Boeddha, C.R., Gundlach, P.J., Verberk-Jonkers, I.A.J.M

Locatie(s): Zaal 0.5

Categorie(ën): Parallelsessie

Introduction: Contrast induced nephropathy (CIN) is an important complication of contrast-based investigations which can cause prolonged hospitalization as well as the start of renal replacement therapy and mortality. The definition of CIN includes an > 25% increase or 44 µmol/l in serum creatinine within 48-72 hours after administration of intravascular iodine-based contrast media, when alternative explanations for renal impairment have been excluded.

Aim of the study: In March 2011 we implemented the VMS theme: prevention of contrast-induced nefropathy after intravascular iodine-based contrast media in our hospital. Here we describe the incidence and outcomes of CIN at our outpatient clinic where all high-risk patients requiring a iodine-based contrast investigation were evaluated.

Material and Methods: We used a computer program which requires obligated data before an iodine-contrast based investigation could be ordered. The program requires recent laboratory data on kidney function as well as other risk factors such as age, hematocrit, hypotension, the presence of diabetes, multiple myeloma, peripheral vascular disease, heart failure and the use of nephrotoxic drugs. The program pointed out high risk patients and these were referred to the CIN outpatient clinic to take adequate hydration measures as well as additional interventions (cessation of nephrotoxic medication, addition of acetylcysteine) to prevent CIN.

Results: Between March 2011 and January 2013, a total of 603 outpatients at high risk for CIN underwent an iodine-contrast based investigation. Sixteen out of 603 (2.7%) developed CIN, with 4 of them having a MDRD between 45-60 , while the others had a MDRD < 45 ml/min/l/1.73 m². CIN was reversible in 14 patients. However, the 2 patients with irreversible CIN were already in the pre-dialysis programme having a MDRD pre-contrast of 10 and 8 ml/min/l/1.73 m², respectively.

Conclusion: The implementation of the VMS theme, using a new computer program as well as coordinated care by the CIN outpatient clinic resulted in a very low incidence of CIN, which was reversible in almost all patients. Only in 2 patients already in the pre-dialysis program CIN resulted in the initiation of renal replacement therapy. Although very safe, this implementation causes high costs mainly due to the required hospitalization for IV hydration, questioning whether the VMS criteria are not too strict. Randomized studies are required to investigate whether the identification criteria of high risk patients in the VMS theme can be adjusted, aiming for a comparable low incidence of CIN with reduced costs.