Effect of an Electronic Alert on Risk of Contrast-Induced Acute Kidney Injury in Hospitalized Patients Undergoing Computed Tomography

• Published in: American journal of kidney diseases Vol. 60; no. 1; pp. 74 - 81
• Main Authors: Cho, AJin, MD, Lee, Jung Eun, MD, PhD, Yoon, Jae Young, MD, Jang, Hye Ryoun, MD, PhD, Huh, Wooseong, MD, PhD, Kim, Yoon-Goo, MD, PhD, Kim, Dae Joong, MD, PhD, Oh, Ha Young, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2012; Elsevier
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnostic imaging; Acute Kidney Injury - physiopathology; Acute Kidney Injury - prevention & control; Adult; Aged; Biological and medical sciences; Computers; Contrast Media - adverse effects; Contrast-induced nephropathy; electronic alert; Female; Glomerular Filtration Rate; Hospitalization; Humans; Kidneys; Male; Medical Order Entry Systems; Medical sciences; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; prophylaxis; Radiographic Image Enhancement; Reminder Systems; Tomography, X-Ray Computed; Urinary system involvement in other diseases. Miscellaneous; electronic alert; prophylaxis; Contrast-induced nephropathy; Kidney disease; Human; Nephrology; Urinary system disease; Radiodiagnosis; Acute kidney injury; Electronics; Hospitalization; Urology; Prevention; Nephropathy; Risk factor; Medical imagery; Computerized axial tomography
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.02.331

Background Prophylaxis against contrast-induced acute kidney injury (AKI) in hospitalized patients is underused. We evaluated the impact of a computerized alert program for contrast-induced AKI for hospitalized patients undergoing contrast-enhanced computed tomography (CT). Study Design Quality improvement report. Setting & Participants 463 adult inpatients in a single center with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Quality Improvement Plan We developed a computer alert program in which the responsible physician was alerted to a patient's risk of contrast-induced AKI in the form of a warning message box and was recommended to consider prophylactic measures for contrast-induced AKI when he or she ordered contrast-enhanced CT for patients with eGFR <60 mL/min/1.73 m2 . The intervention was applied simultaneously to all hospitalized patients from March 18, 2010. The hospital's contrast-induced AKI preventive guidelines included prehydration, posthydration, and oral N -acetylcysteine. Outcome & Measurements Use of prophylactic interventions, development of contrast-induced AKI. Contrast-induced AKI was defined as an increase in serum creatinine level (≥0.3 mg/dL or ≥50%) 24-72 hours after contrast medium exposure. Results 258 adult inpatients with eGFR <60 mL/min/1.73 m2 were identified as undergoing contrast-enhanced CT before application of the computer alert program (from October 28, 2009, to March 17, 2010), and 205, after its application (from March 18, 2010, to August 5, 2010). Individuals in the postalert group received contrast-induced AKI prophylaxis more often than those in the prealert group (55% vs 25% for total prophylaxis; P < 0.001). The incidence of contrast-induced AKI was lower in the postalert group than in the prealert group (3% vs 10%; P = 0.02). Limitations Observation bias; only 61.5% of participants were evaluated for contrast-induced AKI. Conclusions Implementation of a computerized alert program in hospitalized patients was followed by increased use of prophylaxis and decreased risk of contrast-induced AKI.