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  • Measure Summary
  • NQMC:005004
  • Feb 2009

Prevention of contrast-induced renal damage: percentage of patients at risk of developing acute nephropathy to whom a prevention program is applied prior to tests with iodine-containing contrast media.

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to determine the percentage of patients at risk of developing acute nephropathy (plasma creatinine greater than 1.5 mg/dl) to whom a prevention program is applied prior to tests with iodine-containing contrast media. Fluid therapy via two protocols is considered a prevention measure:

  1. 1 ml/kg/hour of crystalloids (saline or hyposaline solution or glucose water), starting 12 hours previous to the diagnostic test and continuing up to 12 hours after the test.
  2. 1,000 ml of water taken orally in the ten hours previous, followed by saline solution administered intravenously at a rate of 300 ml/hour during 30-60 minutes and continued for the next six hours.

The following therapeutic regime must also have been prescribed and administered: 600 mg N-acetylcysteine, taken orally, twice a day one day before and one day after the procedure. In the case of patients allergic to N- acetylcysteine, treatment with theophylline could be considered.

Rationale

Adverse events resulting from the intravenous administration of contrast dye include allergic reactions, anaphylaxis and kidney damage. Contrast media-induced renal failure rarely occurs in patients with normal kidney function, but patients with pre-existing renal insufficiency or other conditions (e.g., diabetic nephropathy, dehydration, congestive heart failure or concurrent administration of nephrotoxic drugs) are at risk for renal failure when given iodine-containing contrast media.

Main aim of indicator: to increase prevention of acute nephropathy resulting from administration of iodine-containing contrast media.

Evidence for Rationale

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

Primary Health Components

Contrast-induced acute nephropathy; prevention program

Denominator Description

Total number of patients at risk of developing contrast-induced nephropathy (plasma creatinine greater than 1.5 mg/dl), excluding patients undergoing extrarenal cleansing techniques

Numerator Description

Number of patients to whom a contrast-induced acute nephropathy prevention program is applied (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

24.1% of patients at risk of developing acute nephropathy undergo a prevention program prior to tests with iodine-containing contrast media.

Evidence for Additional Information Supporting Need for the Measure

Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.

Extent of Measure Testing

After pilot testing, the set of indicators has been measured in a random sample of 25 Spanish hospitals, stratified by hospital size. The main objective has been to field test the feasibility of measurement in the various settings representing real life situations in the context of the Spanish Health Care System.

Both the whole indicators validation report and the results of the baseline measurement in a sample of the Spanish National Health Service (NHS) hospitals may be accessed and downloaded from the Spanish Ministry of Health web page (in Spanish):

Evidence for Extent of Measure Testing

Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p.

Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Safety

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total number of patients at risk of developing contrast-induced nephropathy (plasma creatinine greater than 1.5 mg/dl)

Exclusions
Exclude patients undergoing extrarenal cleansing techniques.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients to whom a contrast-induced acute nephropathy prevention program* is applied

*Fluid therapy via two protocols is considered a prevention measure:

  1. 1 ml/kg/hour of crystalloids (saline or hyposaline solution or glucose water), starting 12 hours previous to the diagnostic test and continuing up to 12 hours after the test.
  2. 1,000 ml of water taken orally in the ten hours previous, followed by saline solution administered intravenously at a rate of 300 ml/hour during 30-60 minutes and continued for the next six hours.

The following therapeutic regime must also have been prescribed and administered: 600 mg N-acetylcysteine, taken orally, twice a day one day before and one day after the procedure. In the case of patients allergic to N- acetylcysteine, treatment with theophylline could be considered.

Exclusions
Exclude patients undergoing extrarenal cleansing techniques.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

None

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients at risk of developing acute nephropathy to whom a prevention program is applied prior to tests with iodine-containing contrast media.

Measure Collection Name

Safe Practices Indicators Project

Measure Set Name

Adopting Safe Practices in Specific Clinical Care Settings or for Specific Processes of Care

Measure Subset Name

Prevention of Contrast Media-induced Renal Damage

Submitter

Spanish Agency for Healthcare Quality of the Spanish Ministry of Health - National Government Agency [Non-U.S.]

Developer

Grupo de Investigación sobre Gestión de la Calidad en Servicios de Salud, University of Murcia, under contract to the Spanish Ministry of Health - National Government Agency [Non-U.S.]

Funding Source(s)

Agency for Quality, Spanish Ministry of Health

Composition of the Group that Developed the Measure

Saturno, Pedro J., MD, DrPH; Group Director and Project PI

Castillo, Carmen; López, M. José; Ramón, Teresa; Nurses

Carrillo, Andrés, MD; Intensive Care Specialist

Iranzo, M. Dolores; Hospital pharmacist

Soria, Victor, MD; Surgeon

Parra, Pedro, MD; Gomis, Rafael, MD; Gascón, Juan J., MD; Quality Management Specialists

Financial Disclosures/Other Potential Conflicts of Interest

Project entirely financed by the Spanish Ministry of Health.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2009 Feb

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

Measure Availability

Source not available electronically.

For more information, contact:

  • Ministry of Health and Social Policy, at Paseo del Prado, 18-20, planta baja, esquina con Lope de Vega. 28014 Madrid; Phone: +34 901 400 100; Fax: +34 915 96 44 80; Web site: www.msc.es/en/home.htm External Web Site Policy.

    OR

  • Pedro J. Saturno, Facultad de Medicina, at Universidad de Murcia, 30100 Espinardo-Murcia (Spain); Phone: 868 883 948; Fax: +34 868 883947; E-mail: psaturno@um.es.

Companion Documents

The following are available:

  • Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p. This document is available in Portable Document Format (PDF) from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).
  • Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p. This document is available in PDF from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).

NQMC Status

This NQMC summary was completed by ECRI Institute on September 11, 2009. The information was verified by the measure developer on December 23, 2009.

This NQMC summary was retrofitted into the new template on July 27, 2011.

The information was reaffirmed by the measure developer on April 4, 2016.

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