RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT. Issue 12 (December 2017) - Cope, L.H.
Abstract : Aim: To determine radiology departmental compliance with current UK guidance on contrast-induced acute kidney injury (CI-AKI) and to provide data on the incidence of clinically significant post-contrast AKI (PC-AKI) in computed tomography (CT) practice. Materials and methods: A questionnaire was sent to all UK acute National Health Service (NHS) providers (NHS boards in Scotland, local health boards in Wales, NHS trusts in England and health and social care trusts in Northern Ireland) to assess compliance of provider protocols with current UK guidelines for the prevention, recognition, and management of CI-AKI. Audit data were collected for 40 consecutive fit outpatients and 40 consecutive acutely unwell patients/inpatients from hospitals within each participating provider to assess clinical compliance. Results: Eighty-nine of 172 (52%) health service providers responded, and data on 7, 159 contrast-enhanced CT examinations were provided. Compliance with guidelines was poor with wide variation in clinical practice. The observed incidence of clinically significant (requiring treatment or resulting in death) PC-AKI was zero in 3, 590 outpatients, although two patients developed AKI due to other causes (sepsis and progressive malignancy). Fourteen out of 3, 569 (0.4%) patients in the inpatient group developed clinically significant PC-AKI, and a further 17 patients were identified who met the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI (Electronic Supplementary Material Appendix S1), but did not require active treatment, giving an overall incidence of AKI of 0.9%. In patients at high risk due to impaired renal function prior to the scan, there was no difference in the median serum creatinine (SCr) before and after contrast medium administration in either group. Conclusion: Health service provider protocols and clinical practice demonstrate poor compliance with current UK guidance on CI-AKI. A very low incidence of PC- AKI was demonstrated. Highlights: 89/172 (52%) trusts responded, and data on 7159 contrast enhanced CT scans were provided. Clinical radiology departments should review their CI-AKI protocol as compliance with current UK guidance on CI-AKI is poor. Departments should develop a protocol to identify OPs with an eGFR <45 ml/min/1.73m 2, arrange follow up kidney function tests and act on the results within the radiology department and have established arrangements with the acute care physicians/renal team for the management of patients identified with CI-AKI.