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

Point-of-care creatinine testing for kidney function measurement prior to contrast-enhanced diagnostic imaging: evaluation of the performance of three systems for clinical utility

“…Clinical practice guidelines recommend targeted screening of kidney function based on individual risk [7,8]. However, due to the silent nature of many forms of kidney disease and complex workflows within diagnostic imaging, it is usual practice for all patients receiving iodinated contrast-enhanced imaging to have had a SCr and eGFR checked prior to the examination [10][11][12][13]. This result establishes whether it is safe for a patient to receive iodinated contrast media and identify if any preventative measures are required or whether contrast media is withheld.…”

“…The highest risk group is considered to be in patients with an eGFR below 30mL/min/1.73m 2 [1], which may, in some health systems result in restriction of iodinated contrast altogether. Despite variation in clinical practice internationally [10][11][12][13] regarding the best way to calculate a patients individual risk and which prevention strategies to implement, testing of kidney function prior to administration of iodinated contrast is uniformly accepted as standard practice.…”

Impact on clinical practice of updated guidelines on iodinated contrast material: CINART

“…a hospital in China, personal communication) or somewhere at the level of 64-87% (e.g. ESUR guideline survey, personal communication) [16].…”

“…When inserting the number of iodinated contrast injections carried out worldwide in Table 2-estimated at 75 million a year in 2005 [18]-and assuming a worldwide average adherence to guideline recommendations of 40% (based on the reported 64-87% adherence in Europe, Oceania, and North America, and a worst-case scenario of zero adherence in Africa, South America, and half of Asia) [16,18], the result estimates would be that over 225,000 patients a year no longer suffer from complications such as symptomatic heart failure associated with the prophylactic treatment, that over 3.5 million patients need no longer be hospitalised for prophylaxis, and that savings for health care budgets are over €2.7 billion, each year.…”

Amacing

“…The incidence of CIN found in the AMACING trial is similar to those found in other elective patient populations. [160][161][162][163] For elective patients with eGFR <30 ml/min/1.73m 2 , there are fewer examples of incidences of CIN in literature, but a large retrospective study in outpatients receiving standard prophylaxis and computed tomography yielded a 10.8% CIN incidence (27/250). 151 Many factors must be taken into consideration when planning a procedure with intravascular iodinated contrast material, and guideline recommendations on safe use of intravascular contrast material are much broader than the recommendation of prophylactic intravenous hydration alone.…”