Kidney Week

Abstract: PO2524

Effect of Clinical Decision Support with Audit and Feedback for Prevention of AKI in Coronary Angiography and Intervention: Stepped Wedge Cluster Randomized Trial

Session Information

• Late-Breaking Clinical Trials Posters
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• James, Matthew T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Matthew T. James,

• Har, Bryan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Bryan J. Har,

• Tyrrell, Benjamin D., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Benjamin D. Tyrrell,

• Faris, Peter D., Alberta Health Services, Calgary, Alberta, Canada

Peter D. Faris,

• Tan, Zhi, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Zhi Tan,

• Spertus, John, University of Missouri, Columbia, Missouri, United States

John Spertus,

• Wilton, Stephen B., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Stephen B. Wilton,

• Ghali, William A., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

William A. Ghali,

• Knudtson, Merril L., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Merril L. Knudtson,

• Pannu, Neesh I., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Neesh I. Pannu,

• Klarenbach, Scott, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Scott Klarenbach,

• Graham, Michelle M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada

Michelle M. Graham,

Background

Contrast-associated acute kidney injury (CA-AKI) is a common complication of coronary angiography and percuateous coronary intervention (PCI). We evaluated whether the incidence of CA-AKI was reduced with an intervention including clinical decision support with audit and feedback.

Methods

In this cluster-randomized, stepped-wedge trial conducted in Alberta, Canada, we randomly assigned all invasive cardiologists to various start dates for an intervention that included education, point-of-care computerized clinical decision support on contrast volume and IV fluid targets, and repeated audit and feedback related to these processes for CA-AKI prevention. The eligible study population included adults ≥18 years of age, not receiving dialysis, with a predicted risk of CA-AKI >5%, who received non-emergency coronary angiography or PCI. The primary outcome was incidence of AKI based on the KDIGO serum creatinine criteria. Analyses were performed according to the intention-to-treat principle, using mixed-effect models to account for clustering in the data.

Results

Of 34 physicians randomized, 3 retired prior to randomization, and the remaining 31 received the intervention. There were 7,087 procedures performed in 6,449 eligible patients; mean (SD) age 70.2 (10.7) years, 2,292 (32.3%) female, mean (SD) eGFR 62.7 (22.4) mL/min/1.73m². The proportion of procedures where the desired contrast volume limit was exceeded was reduced from 41.0% to 29.2% (p<0.01), while the proportion who received hemodynamically guided IV fluids increased from 35.3% to 42.0% (p<0.01) with the intervention. The incidence of CA-AKI was significantly reduced, from 9.2% (280 events / 3,036 procedures) before the intervention to 8.2% (334 events / 4,051 procedures) with the intervention (time adjusted odds ratio, 0.74; 95% CI, 0.58 to 0.94). There was no statistical evidence of effect modification by age, sex, comorbidity, or baseline CA-AKI risk.

Conclusion

An intervention combining education, clinical decision support, and audit and feedback resulted in less contrast dye use, greater intravenous fluid administration, and reduced the incidence of CA-AKI following coronary angiography and PCI.

Funding

• Government Support - Non-U.S.