Contemporary Practice Patterns Related to the Risk of Acute Kidney Injury in the Catheterization Laboratory: Results From an International Survey of Society of Cardiovascular Angiography and Intervention (Scai) Cardiologists

Abstract

Objectives: 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 5 0.003), obtain nephrology consultation (45.2% vs. 13.3%, P 5 0.016) and use iso-osmolar contrast agents (56.0% vs. 26.7%, P 5 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. V C 2016 Wiley Periodicals, Inc.

Contrast-Induced Nephropathy Following Peripheral Angiography With Carbon Dioxide Versus Iodinated Contrast Media: A Systematic Review and Meta-Analysis of Current Literature

“…As the prevalence of diabetes, CKD, and peripheral arterial disease (PAD) continues to rise, an increasing number of patients will present for endovascular therapy and be exposed to the risk of CI-AKI [44]. The use of digital subtraction imaging with ICM remains the most common angiographic approach in patients with symptomatic PAD [45]. Pharmacologic measures to reduce the incidence of CI-AKI have been largely ineffectivewith volume expansion and minimization of ICM as the most adopted techniques to prevent this complication.…”