Type of publication:
Conference abstract
Author(s):
*Kanthasamy V., *Gill S.
Citation:
Global Heart, June 2016, vol./is. 11/2 SUPPL. 1(e94)
Abstract:
Introduction: Contrast induced acute kidney injury(CI-AKI) is one of the potential risk involved in high risk patients who undergo Coronary Angiography/interventions. As the procedure involved intra-arterial administration of contrast media, it expose the patient directly to the toxic side effects. It classically occurs within 72 hours of receiving the contrast media and usually recovers over the following five days. Its incidence increases significantly among the patients with risk factors and is greatly associated with short and long term mortality. The risk of CI-AKI is has been reported as high as 25% in patients with combination of CKD and diabetes, Cardiac failure, older age and exposure to nephrotoxic agents. Objectives: A clinical audit performed in order to assess the adherence to the NICE guidelines to prevent contrast induced Acute Kidney Injury among CKD patients undergoing diagnostic Coronary Angiogram and to identify the incidence of AKI following the procedure. Methods: A retrospective clinical audit was conducted to cover 6 months from May to October 2014. Data was collected from the cath lab register and patients with chronic kidney disease with eGFR<60 were included in the audit covering both in-patient and outpatient procedures(n=30). Data collection was based on the NICE guidance to look for the adherence of monitoring for renal function pre/post angiogram and considering hydration as preventive measure. Results: 93 % of the patients had two or more risk factors including CKD. All patients had renal function checked prior to the procedure but only 57 %(n=17) had post procedure renal function checked within 1 week and only 53 % were hydrated. 10 out of 17 patients( 59%) showed a decline in renal function. Among them 4 (23%) patients had AKI as per KDIGO criteria (Kidney Disease: Improving Global Outcomes) and of which 3 (75%) were not hydrated pre/post procedure. Renal function did not return to baseline in one of those 4 patients. Conclusion: In overall it was clearly evident that taking preventive measures against CIAKI in CKD patients were overlooked. Our recommendations were to introduce a checklist pre & post procedure for all patients so that high risk patients can be identified, to instruct the GP(on discharge) to re-check the renal functions in 3 days and to re-audit.