Ian McCoy, MD, MS is a board-certified nephrologist who treats kidney disease of all kinds. Dr. McCoy is active in clinical research with a particular interest in acute kidney injury and diuretic use in the intensive care unit. He is also involved in quality improvement, leading the Draw on Dialysis project at Stanford Hospital to draw non-urgent inpatient labs on dialysis rather than by peripheral phlebotomy in order to save patient pain and peripheral veins for future dialysis access. He is currently continuing a post-doctoral research fellowship, with the goal of becoming an independent clinical investigator.
Clinical Instructor, Medicine - Nephrology
Honors & Awards
Gold Heart Pin for Compassionate Care, West Roxbury Veterans Affairs Hospital (2014)
CSRP Recognition Award for Value-Based Care, Stanford Hospital and Clinics (2018)
Master of Science, Stanford University, EPIDM-MS (2019)
Masters of Science, Epidemiology and Clinical Research, Stanford University School of Medicine, CA (2019)
Board Certification: Nephrology, American Board of Internal Medicine (2018)
Fellowship, Stanford University Division of Nephrology, CA (2018)
Board Certification: Intern Med, American Board of Internal Medicine (2016)
Residency, Beth Israel Deaconess Medical Center, MA (2016)
Doctor of Medicine, The University of Texas Southwestern Medical School, TX (2013)
Current Research and Scholarly Interests
As a nephrologist working in diverse practice settings including the intensive care unit (ICU), I regularly face the limitations of current clinical tools for assessing a patient's volume status and for guiding patient selection for diuretic therapy. I work with a large, detailed clinical database (MIMIC-III) to study current patterns of diuretic use in the ICU, estimated effects of diuretic use, and clinical features that may predict outcomes in critically ill patients receiving diuretics.
I am also involved in quality improvement. I lead the Draw on Dialysis project, which aims to draw non-urgent inpatient labs on dialysis rather than by peripheral phlebotomy in order to save patient pain and peripheral veins for future dialysis access. I am also interested in leveraging nationwide databases such as Optum claims data to assess adherence to guidelines in kidney care.
Comparing Diuretic Strategies in Hospitalized Heart Failure
We will conduct a pragmatic randomized trial comparing whether using a combination of two types of diuretics (loop + thiazide) compared with using a single diuretic (loop only) will result in shorter hospital stays for patients hospitalized with heart failure.
Stanford is currently not accepting patients for this trial.
Central venous pressure and the risk of diuretic-associated acute kidney injury in patients after cardiac surgery.
American heart journal
2019; 221: 67–73
When prescribing diuretics in the postcardiac surgical intensive care unit (ICU), clinicians may use central venous pressure (CVP) to assess volume status and the risk of acute kidney injury (AKI). In this study, we examined how the risk of diuretic-associated AKI varied with CVP in patients undergoing cardiac surgery.We used the Medical Information Mart for Intensive Care database to study adults admitted to the postcardiac surgical ICU at an urban, academic medical center between 2001 and 2012. We examined the odds of AKI per 1-mm Hg increase in CVP among patients receiving intravenous loop diuretics using multivariable adjusted logistic regression. We examined the risk of AKI among patients with diuretic use (vs nonuse) across tertiles of CVP using inverse probability treatment weighting.Among 4,164 patients receiving intravenous loop diuretics, the adjusted odds of subsequent AKI were 1.11 (95% CI 1.08-1.13) times higher per mm Hg increase in mean CVP. This association was log-linear across the entire range of CVPs observed. In the analysis of diuretic use (n = 5,396), the adjusted risk ratio for AKI with diuretic use (vs nonuse) was 1.33 (95% CI 1.21-1.47) and did not materially differ across tertile of CVP.Higher rather than lower CVP is an independent marker of AKI risk. The risk of AKI associated with diuretic use may not be influenced by CVP. Novel methods of assessing volume status and AKI risk are needed to guide patient selection for diuretic therapy.
View details for DOI 10.1016/j.ahj.2019.12.013
View details for PubMedID 31931418
Patterns of diuretic use in the intensive care unit.
2019; 14 (5): e0217911
To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and inclusion of an initial bolus with continuous furosemide infusions.In this descriptive study, we retrospectively studied 46,037 adult ICU admissions from a publicly available database of patients in an urban, academic medical center.Diuretics were employed in nearly half (49%, 22,569/46,037) of ICU admissions. Mechanical ventilation, a history of heart failure, and admission to the post-cardiac surgery unit were associated with a higher frequency of diuretic use. Combination use of different diuretic classes was uncommon. Patients with severely impaired kidney function were less likely to receive diuretics. Furosemide was by far the most common diuretic given and the initial intravenous dose was only 20 mg in more than half of ICU admissions. Among patients treated with a continuous infusion, 30% did not receive a bolus on the day of infusion initiation.Patterns of diuretic use varied by patient-specific factors and by ICU type. Diuretic dosing strategies may be suboptimal.
View details for DOI 10.1371/journal.pone.0217911
View details for PubMedID 31150512
Estimated effects of early diuretic use in critical illness.
Critical care explorations
2019; 1 (7)
To estimate the effects of diuretic use during the first 24 hours of an intensive care unit stay on in-hospital mortality and other clinical outcomes including acute kidney injury and duration of mechanical ventilation.Retrospective cohort study.Urban, academic medical center.Adult patients admitted to medical or cardiac ICUs between 2001 and 2012, excluding those on maintenance dialysis or with ICU length of stay < 24 hours.None.We included 13,589 patients: 2,606 with and 10,983 without early diuretic use (loop diuretic exposure during the first 24 hours of an ICU stay). Propensity score matching generated 2523 pairs with well-balanced baseline characteristics. Early diuretic use was unassociated with in-hospital mortality (risk ratio 1.01, 99.5% confidence interval 0.83-1.22). We found no evidence of associations with ICU or hospital length of stay, or duration or provision of mechanical ventilation. Early diuretic use was associated with higher rates of subsequent acute kidney injury (risk ratio 1.41, 99.5% confidence interval 1.25 to 1.59) and electrolyte abnormalities. Results were not materially different in subgroups of patients with heart failure, chronic kidney disease, or acute lung injury.Early diuretic use in critical illness was unassociated with in-hospital mortality, ICU or hospital length of stay, or duration of mechanical ventilation, but risks of acute kidney injury and electrolyte abnormalities were higher.
View details for DOI 10.1097/CCE.0000000000000021
View details for PubMedID 31440746
View details for PubMedCentralID PMC6705600