Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit

Y Jia; M Szewczyk-Bieda; R Greenhalgh; K Drinkwater

doi:10.1016/j.crad.2023.07.017

Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit

Clin Radiol. 2023 Nov;78(11):e898-e907. doi: 10.1016/j.crad.2023.07.017. Epub 2023 Aug 22.

Authors

Y Jia¹, M Szewczyk-Bieda², R Greenhalgh³, K Drinkwater⁴

Affiliations

¹ Department of Medicine, Imperial College London, London, UK. Electronic address: yj7218@ic.ac.uk.
² Department of Clinical Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK.
³ Department of Radiology, London North West University Healthcare NHS Trust, London, UK.
⁴ Directorate of Education and Professional Practice, The Royal College of Radiologists, London, UK.

PMID: 37612224
DOI: 10.1016/j.crad.2023.07.017

Abstract

Aim: To audit UK radiology departmental protocols related to the prevention of Iodine-based contrast media (ICM) adverse drug reactions (ADRs) and to assess their compliance with the Royal College of Radiologists (RCR) endorsed Royal Australian and New Zealand College of Radiologists' 2018 Iodinated Contrast Guidelines.

Materials and methods: Questionnaires were sent to all UK acute National Health Service (NHS) providers treating adult patients with an audit lead registered with the RCR (162 providers encompassing 211 hospital radiology departments). The questionnaire included three main sections: renal function screening, renal protection regimens, and hypersensitivity reactions prevention and follow-up. Data collection was conducted between April and July 2022.

Results: Sixty-one per cent (129/211) of departments responded, representing 67% of eligible providers. An independent imaging services provider supplied one additional set of data (n=130 overall). Of the responding departments, for post-contrast acute kidney injury (PC-AKI), 41% and 56% had the recommended risk assessment for inpatients and outpatients, respectively. Renal function testing was often over-utilised, and their results were applied improperly. Sixty-eight per cent of departments used the advised threshold for considering renal protection. For hypersensitivity reactions, 9% of departments had the correct risk assessment. Thirty-six per cent of departments had the correct risk mitigation protocol for identified high-risk patients. The documentation and follow-up for hypersensitivity reactions were similarly inadequate.

Conclusion: Local protocols on preventing ICM ADRs were largely non-compliant with RCR guidelines. Departments need to update their protocols in line with current evidence to avoid iatrogenic morbidity or unnecessary tests and over-precaution.