Clinical Audit of the Incidence and Documentation Quality of Contrast-Induced Nephropathy (CIN) in a Tertiary...

Contrast-induced nephropathy (CIN) is a potentially preventable form of acute kidney injury triggered by intravascular iodinated contrast, with risk reduction achievable through hydration and appropriate patient selection. Reliable diagnosis requires accurate pre- and post-procedure serum creatinine monitoring. Missing creatinine documentation can significantly impair the detection of true CIN incidence.

To assess CIN incidence, evaluate adherence to renal protection protocols, and quantify missing creatinine documentation among patients undergoing contrast procedures.

A retrospective clinical audit was conducted from January to August 2025, involving 172 patients undergoing contrast-based cardiology procedures. Patients were divided equally into Cycle 1 (January-April 2025, n=86) and Cycle 2 (May-August 2025, n=86). Cycle 1 included patients with both complete and incomplete creatinine documentation, while Cycle 2 comprised exclusively fully documented patients. CIN was defined per the European Society of Urogenital Radiology (ESUR) criteria as an absolute rise in serum creatinine of ≥0.5 mg/dL or a relative rise of ≥25% from baseline within 48-72 hours, or per the Kidney Disease: Improving Global Outcomes (KDIGO) criteria as ≥0.3 mg/dL or ≥50% rise.

Among the 172 patients, 39 (22.7%) had at least one missing creatinine measurement. Specifically, 4 patients (2.3%) lacked pre-procedure values, 37 (21.5%) lacked post-procedure values, and 2 (1.1%) lacked both (accounted for in both categories). The two patients missing both measurements are included in both the pre- and post-procedure missing categories. All 39 patients with missing documentation belonged to Cycle 1. Cycle 2 demonstrated 100% compliance with creatinine documentation. Due to missing post-procedure data, CIN incidence could not be fully assessed in Cycle 1. No CIN cases were identified in Cycle 2 among patients with complete data.

The audit revealed that missing post-procedure creatinine documentation was the primary barrier to accurate CIN detection. Targeted interventions, including mandatory creatinine order sets, electronic medical record (EMR) prompts, and checklist integration, are recommended. Documentation improved in Cycle 2, supporting the benefit of workflow reinforcement. A re-audit is planned following the implementation of corrective measures.