Evaluating the Incidence of Contrast Induced Nephropathy in Patients Undergoing Heart Catheterizations with Proposed Protocol for Optimizing Outcomes

Purpose: To evaluate current methods of hydration for prevention of contrast induced nephropathy (CIN) in patients undergoing heart catheterizations using radiocontrast media at Central Arkansas Veteran's Health Care System (CAVHS) and to develop a hydration protocol and CIN risk score based on the Mehran protocol.

Methods: Medical charts for 100 inpatients at CAVHS between October 20, 2011 and January 28, 2012 were reviewed. Patients were evaluated for percentage risk of developing CIN based on the Mehran score, appropriateness of hydration based on the proposed hydration protocol, and the incidence of CIN. A hydration protocol and CIN risk analysis will be proposed for implementation into the Computerized Patient Records System (CPRS).

Results: One hundred patients were evaluated according to the Mehran protocol. The calculated risk for CIN was as follows:  54 patients had a 7.5% risk, 32 patients had a 14% risk, 9 patients had a 26.1% risk, and 3 patients had a 57.3% risk. Two patients were excluded from the study.  Fifty-one patients received pre-catheterization hydration that was consistent with the proposed hydration protocol. One patient (2.2%) developed CIN during the specified time frame. There were 53 patients who did not have a serum creatinine drawn post-catheterization. Eleven patients did not receive any pre-catheterization hydration.

Conclusion: The incidence of CIN after undergoing a heart catheterization appears to be low at CAVHS. Also, documentation of the volume of contrast used occurred in 100% of the patients evaluated. Hydration for prevention of CIN in this patient population should be standardized. Implementation of a hydration protocol and CIN risk analysis based on the Mehran score will standardize fluid administration. Hopefully, this will also decrease the number of renal consults for patients undergoing heart catheterizations.