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Review of Contrast-Induced Acute Kidney Injury (CI-AKI) Prevention Protocol in an Outpatient Cohort at Our Institution
Chan V, Gibson M, Mohteshamzadeh M
Renal Unit and Radiology Department, Royal Berkshire NHS Foundation Trust, Reading, UK
INTRODUCTION:
Patients with chronic kidney disease are at greater risk of contrast-induced acute kidney injury (CI-AKI). We evaluated the effectiveness of our institution’s CI-AKI prevention protocol in outpatients undergoing contrast-enhanced computed tomography (CECT). Patients with aneGFR of <45 would have nephrotoxic medication withheld as appropriate and an assessment of their fluid status. These patients would also receive intravenous volume expansion with 1.5L 0.9% saline on the day of CT and have their creatinine levels checked 3 days after CT.
METHODS:
We performed a retrospective review of all outpatients having CECT with eGFR<45 from August 2012 to March 2013. Data on patient’s age, serum creatinineand eGFR levels before and after CECT were collected. The Kidney Disease Improving Global Outcomes (KDIGO) CI-AKI definition: ≥1.5x serum creatinine rise from baseline after contrast exposure was used.
RESULTS:
286 cases were performed over the 8-month period. Data from 14 patients were unavailable, 2 were already on dialysis, hence 270 cases were reviewed. The median creatininewas 152 (range 100 - 334) before CECT and 145 (range 61-614) after CECT; median eGFR was 36 (range 15 - 44) before CECT. Based on the KDIGO CI-AKI definition, 6/270 (2.2%) patients developed CI-AKI; 4 had a transient rise in creatinine levels, whilst 2 had a persistently raised creatinine level. None required dialysis or hospital admission.
DISCUSSION:
To minimise the incidence of CI-AKI, it is necessary to identify patients at risk, minimise risk factors, have prevention strategies, follow-up and address any associated long-term adverse outcomes. The CI-AKI prevention protocol at our institution has enabled nurses to administer fluid to patients appropriately without the need for doctor’s prescription. In addition, the Radiology department at our institution has appointed a CI-AKI prevention co-ordinatorand eGFR levels of all patients prior to CECT are monitored closely. From the results of our review, the incidence of CI-AKI in this outpatient group was low and no patients came to serious harm.In contrast, an inpatient cohort have a higher risk in developing CI-AKI as they often present acutely and have multiple or active medical conditions.
CONCLUSION:
Our CI-AKI prevention protocol is simple, easy-to-follow and safe with a low incidence of CI-AKI in this outpatient cohort. As the prevention protocol differs in an inpatient cohort, future audit to review the CI-AKI incidence in an inpatient cohort would prove useful.