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Efforts in Michigan to curb contrast-induced acute kidney injury (AKI) after percutaneous coronary intervention (PCI) managed to bring the risk of renal impairment down over 7 years, a team of researchers there reported.

Clinicians achieved their goal of bringing down contrast-induced AKI rates below 3% at 48 participating hospitals of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. The risk-adjusted rate dropped from approximately 3.3% in 2010 to approximately 2.4% in 2016, according to a group led by Hitinder Gurm, MBBS, of the University of Michigan Cardiovascular Center in Ann Arbor.

At the same time, as reported in the research letter in , contrast uses were on their way down. When the researchers adjusted for estimated glomerular filtration rate (GFR) as a measure of renal function, they found that the average contrast volume-to-GFR ratio fell from a median 2.53 to 2.23 over the study period. The proportion of patients exceeding a contrast volume-to-GFR ratio of 3 also fell from 36% to 25%.

"Although observational findings cannot be used to ascribe causality, the decline in AKI rates that was observed in parallel with the reduction in contrast volumes is noteworthy," the team said. AKI was defined as an elevated serum creatinine level of 0.5 mg/dl or more.

The investigators noted that the way that Michigan hospitals were able to get kidney injury under control was a combination of the following several factors:

• Development and sharing of best-practice protocols across the participating sites
• Inclusion of site-level ranking with regards to contrast-induced AKI incidence in quarterly and annual reports
• Discussion of appropriate risk stratification, hydration, and contrast volume reduction at quarterly collaborative meetings
• Funnel plots for operator level and institutional risk-adjusted outcomes provided to catheterization laboratory directors annually to facilitate outlier detection and guide quality-improvement efforts

"Our experience reflects findings from all nonfederal hospitals and all interventional cardiologists in the State of Michigan and suggests that such efforts can be broadly applied, with resultant observable improvement in care process and patient outcome," Gurm's group suggested, citing a recent finding that contrast use and AKI risk were highly variable across the U.S.

The dataset included 182,196 consecutive patients who had PCI in Michigan; excluded were those already on dialysis at the time of PCI, among other groups.

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