Clinical Decision Support to Reduce Contrast-Induced Kidney Injury During Cardiac Catheterization: Design of a...

Area of Science:

• Cardiology
• Nephrology
• Health Services Research

Background:

• Contrast-induced acute kidney injury (CI-AKI) is a significant complication following invasive cardiac procedures.
• While quality improvement programs show promise, high-quality evidence on clinical decision support for CI-AKI prevention is lacking.

Purpose of the Study:

• To implement and evaluate an evidence-based, multifaceted intervention to reduce CI-AKI incidence.
• To assess the impact of clinical decision support on CI-AKI prevention strategies and patient outcomes.

Main Methods:

• The Contrast-Reducing Injury Sustained by Kidneys (Contrast RISK) study employs a cluster-randomized stepped-wedge design across Alberta's cardiac catheterization labs.
• The intervention includes automated risk identification, point-of-care guidance, personalized fluid optimization recommendations, and follow-up.
• Implementation utilizes cardiologist academic detailing, computerized decision support, and audit/feedback mechanisms.

Main Results:

• Primary outcome: CI-AKI incidence.
• Secondary outcomes: CI-AKI avoidance strategies, major adverse kidney and cardiovascular events.
• Economic evaluation will be conducted alongside the trial.

Conclusions:

• The Contrast RISK study utilizes health IT, evidence-based protocols, and feedback to mitigate CI-AKI in cardiac catheterization.
• Successful implementation could lead to broad scalability and improved cardiac catheterization safety.