Strategies for assessing renal function prior to outpatient contrast-enhanced CT: a UK survey

Abstract

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.

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.…”

“…It is therefore very important that the kidney function result is available and that this is accurate and reliable. In practice, problems with availability of a kidney function result can lead to significant implications for patients in terms of delay in diagnosis and reduction in service efficiency [10,15]. These issues may be addressed by the introduction of PoC technology.…”

“…The i-STAT and the StatSensor have been evaluated most frequently in the diagnostic imaging literature [14][15][16][17][18][19][20][21][22][23][24][25] and are available in a small number of clinical departments across the UK [10]. The sampling techniques used in this study mirror how they are being used in practice.…”

“…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.…”

“…However, the literature reveals both disparity in clinical concordance with the central laboratory and the clinical utility of PoC in clinical practice and adoption has therefore been limited [10]. Importantly, even where they are available in diagnostic imaging departments, such devices have been widely integrated into the clinical pathway.…”