Cardiology Guidance on Prevention of Contrast-Induced Acute Kidney Injury ( CI-AKI ) in Patients undergoing Invasive Procedures

Publication: 03/10/2017  --
Last review: 01/01/1900  
Next review: 01/10/2020  
Clinical Guideline
CURRENT 
ID: 5207 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Cardiology Guidance on Prevention of Contrast-Induced Acute Kidney Injury (CI-AKI) in Patients undergoing Invasive Procedures

Purpose of guidance
Risk Factors for CI-AKI
Recommendations

Purpose of guidance

To summarise existing LTHT guidance on prevention of acute kidney injury for use by doctors and nurses in Cardiology, and to provide advice to patients undergoing day case elective procedures when assessed in pre-admission clinics.

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Risk Factors for CI-AKI

Inherent Risk Factors

  • age > 75 years
  • chronic kidney disease (adults with an eGFR < 40 ml/min/1.73 m2 are at particular risk)
  • diabetes mellitus (but only if eGFR < 40 ml/ min/1.73 m2)
  • heart failure
  • kidney transplant

Exposure Risk Factors

  • AKI
  • sepsis
  • hypovolaemia
  • toxins – e.g. NSAIDs, gentamicin
  • volume of contrast agent
  • type of iodinated contrast
  • iodinated intra-venous or intra-arterial contrast received within the previous 48 hours

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Recommendations

eGFR mls/min/1.73m2

In-Patients

Out-Patients (day-case)

>60

encourage oral fluids

encourage oral fluids

40-59

oral hydration pre and post (drink 1L prior to volume expand)

oral hydration pre and post (drink 1L prior to volume expand)

<40

volume status assessment
0.9% saline at 1ml/kg for 8-12 hours pre- and post-procedure with-hold Metformin NSAIDs U&E check 48-72 hours post- procedure

encourage oral hydration pre-procedure
volume status assessment
0.9% saline at 3ml/kg for 1 hours
pre- and 1ml/kg for 6 hours post- procedure
with-hold Metformin & NSAIDs U&E check 48-72 hours post- procedure
If contrast volume used is >4ml/kg
(or 350mls) further contrast should be avoided for 2 weeks if possible

Notes

  • Patients with eGFR <40 mls/min/1.73m2 and a history of heart failure, LVEF<40% or significant valve disease require clinical assessment to guide management
  • Patients with eGFR <40 mls/min/1.73m2 require U&Es to be checked 48-72 hours post-procedure. Leeds residents should usually be asked to attend L14 or L19 for U&Es to be checked. In other cases, U&Es may be checked in primary care. A rise in serum creatinine of ≥26 μmol/L within 48 hrs or rise ≥1.5 x baseline within 1 week is indicative of AKI and clinical assessment is required.

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Provenance

Record: 5207
Objective:
Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Pharmacists
Adapted from:

This guidance was adapted from LTHT ‘Acute Kidney Injury In Adults’ Guideline


Evidence base

Not supplied

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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