Abstract 4137708: Implementation of a Standard Hydration Protocol Improves Compliance of Pre-procedural Hydration, Reducing the Incidence of Contrast-Induced Acute Kidney Injury (CI-AKI) After Percutaneous Coronary Intervention (PCI)

Introduction: Intravenous hydration and contrast media volume reduction are the most important preventive factors against CI-AKI after PCI. Multiple studies have demonstrated the effectiveness of intravenous hydration before PCI, however, varied hydration protocols have rather complicated standardization. Doctors’ preferences and local institutional factors further hinder protocol implementation, resulting in reduced compliance. Hypothesis: Standardizing hydration protocol increases the compliance rate of preprocedural hydration orders and administration, reducing the incidence of CI-AKI. Methods: A team at Memorial Hermann The Woodlands Medical Center, comprising a cardiovascular nurse coordinator, catheterization laboratory director, pharmacist, information technologist, and hospital administrators, was formed to improve PCI outcomes through a multi-faceted approach. This involved a standardized hydration protocol with direct education, continuous monitoring, and repeated internal feedback, reviewed monthly. The new protocol included normal saline pre- and post-procedure maintenance fluids, with a 250 ml normal saline bolus pre-operatively. Maintenance fluids were set at 75 ml/hr, and 20 ml/hr for patients with congestive heart failure and an ejection fraction ≤ 40%. The team reviewed 233 patients under the old protocol and 281 under the new protocol. Compliance rates of pre-procedural intravenous hydration were compared and CI-AKI incidence, defined as a >50% increase or a 0.3 mg/dL increase in creatinine levels within 5 days post-procedure, was assessed. Chi square tests and t-tests were used to compare cohorts on 12 parameters and CI-AKI incidence assessment, with a p-value of 0.05. Results: Compliance with pre-procedural hydration significantly increased under the new protocol (86.1% vs 55.4%, p<0.05). CI-AKI incidence was lower in the new protocol group (7.5% vs 9.9%, p=0.33). Although statistically insignificant in this preliminary analysis, the results were still promising due to a relative CI-AKI reduction of 24.3%. A sample size of 352 patients per group is needed to achieve a power of 0.8. Conclusion: The new standardized hydration protocol, coupled with education, increased compliance with pre-procedural hydration and showed a promising trend towards reducing CI-AKI among PCI patients. The final report will be presented upon study completion.