OBJECTIVE: To identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. METHODS: An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. RESULTS: A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. CONCLUSION: The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. Advances in knowledge: This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.
OBJECTIVE: To identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. METHODS: An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. RESULTS: A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. CONCLUSION: The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. Advances in knowledge: This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.
Authors: James Tumlin; Fulvio Stacul; Andy Adam; Christoph R Becker; Charles Davidson; Norbert Lameire; Peter A McCullough Journal: Am J Cardiol Date: 2006-02-17 Impact factor: 2.778
Authors: Floris Vanommeslaeghe; Elien De Mulder; Cedric Van de Bruaene; Laurens Van de Bruaene; Norbert Lameire; Wim Van Biesen Journal: Nephrol Dial Transplant Date: 2015-06-04 Impact factor: 5.992
Authors: Robert J McDonald; Jennifer S McDonald; Rickey E Carter; Robert P Hartman; Richard W Katzberg; David F Kallmes; Eric E Williamson Journal: Radiology Date: 2014-09-09 Impact factor: 11.105
Authors: Matthew S Davenport; Shokoufeh Khalatbari; Richard H Cohan; Jonathan R Dillman; James D Myles; James H Ellis Journal: Radiology Date: 2013-04-11 Impact factor: 11.105
Authors: Michele Andreucci; Teresa Faga; Antonio Pisani; Massimo Sabbatini; Ashour Michael Journal: Biomed Res Int Date: 2014-08-14 Impact factor: 3.411
Authors: Mark Corbett; Ana Duarte; Alexis Llewellyn; James Altunkaya; Melissa Harden; Martine Harris; Simon Walker; Stephen Palmer; Sofia Dias; Marta Soares Journal: Health Technol Assess Date: 2020-08 Impact factor: 4.014