According to the CathPCI Registry Version 5.0 (and continued in 6.0):
AKI is defined as an absolute increase in serum creatinine ≥ 0.3 mg/dL or a relative increase of ≥ 50% from baseline within 48 hours after the procedure.
This definition aligns with the KDIGO (Kidney Disease: Improving Global Outcomes) criteria and is used to track kidney injury following cardiac catheterization or percutaneous coronary intervention (PCI).
Overview: VCSQI AKI Reduction Recommendations – Real-World Impact
The VCSQI AKI Reduction Recommendations and Suggestions for Care represent a powerful, data-informed initiative developed by the VCSQI AKI Workgroup to reduce the risk of Acute Kidney Injury (AKI) in cardiac surgery. Originally released in January 2022 and revised in January 2023, the guidelines provide actionable, evidence-based strategies across the preoperative, intraoperative, and postoperative phases of care.
Key focus areas include:
Identifying and managing nephrotoxic risks
Optimizing fluid and contrast administration
Enhancing intraoperative monitoring
Supporting postoperative renal protection
Goal-Directed Perfusion Bundle
These strategies were designed to be practical, adaptable, and impactful in both surgical and cardiology workflows.
Impact: Measurable Improvements Among Adopting Sites
Data from 2018 to 2024 show that sites with confirmed implementation of the AKI protocol experienced notable improvements in outcomes:
Average AKI rates decreased from 32.15% to 30.66%
Several sites saw double-digit improvements, with reductions of up to 28%.
This group achieved a cumulative average improvement of 4.63%
These outcomes demonstrate that the AKI strategies are more than recommendations—they're a proven framework for reducing complications and improving patient safety.
Engagement Across the Collaborative
The non-adopter group includes sites for which protocol implementation has not been formally confirmed. These hospitals may have independently adopted some, all, or none of the suggested practices.
Despite that variability, this group still showed a 5.44% overall relative improvement, indicating that many sites may already be employing strategies aligned with the AKI protocol. However, the data suggest that confirmed adopters experienced more consistent and substantial improvements in AKI outcomes.
This insight reinforces the importance of intentional, protocol-based approaches to kidney protection and the value of shared learning across the collaborative.
The Path Forward
As we continue to learn and improve together, we encourage all sites to explore the VCSQI AKI Reduction Recommendations and consider formal implementation. The data clearly support their effectiveness, and continued collaboration will help ensure the best possible outcomes for all patients across the region.