Ken Shaji
Introduction
Contrast-induced AKI (CI-AKI) is a preventable complication in patients with impaired renal function undergoing contrast-enhanced CT scans. King’s College Hospital guidelines recommend IV hydration before and after imaging and monitoring of renal function within 72 hours. A first-cycle audit (Dec 2022–Sep 2023) revealed poor compliance. This second-cycle audit evaluates whether improvements have been made, using data from April - November 2024. Adequate hydration remains a simple yet critical measure in preventing CI-AKI, which can lead to serious complications.
Methods
A retrospective review was conducted using EPIC records for surgical inpatients with low eGFR who underwent CT scans. Data were assessed for documentation of IV fluid administration and renal function monitoring. Accuracy and eligibility were confirmed via cross-referencing with the electronic patient record. 30 patients were included (67% male, 33% female).
Results
Overall compliance with all guideline elements remained low at 27%, unchanged from the first cycle. Of the 19 patients (63%) who received both pre- and postscan hydration, 14 (74%) showed improvement in eGFR. However, 17 patients (63%) received incorrect fluids and had no follow-up renal monitoring. Among the 11 patients who received no hydration, 5 (45%) experienced a decline in renal function.
Conclusion
Results were shared with General Surgery and Radiology teams via teaching sessions. Targeted education for junior doctors and placement of guideline posters in clinical areas have been implemented. This audit highlights the ongoing need for staff education and system-level interventions to improve compliance. Our findings reinforce that appropriate hydration significantly reduces the risk of CI-AKI.
Authors
Greshma Sunny
King's College Hospital, London, United Kingdom
Beebee Zeba Mahetaab Mubarak Jan
King's College Hospital, London, United Kingdom
Mary Villegas
King's College Hospital, London, United Kingdom
Ali Frak
King's College Hospital, London, United Kingdom
Ahmed Helmy
King's College Hospital, London, United Kingdom
Ken Shaji
King's College Hospital, London, United Kingdom