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Utility of Patient-Reported Risk Factors for Identifying Advanced Chronic Kidney Disease Prior to Outpatient CT: Comparison With Recent ACR/NKF Consensus Criteria.

Background: Practices vary for screening patients for risk of renal dysfunction before iodinated contrast media administration. A recent American College of Radiology/National Kidney Foundation (ACR/NKF) consensus statement provided streamlined screening criteria. Objective: To assess the yield of patient-reported risk factors for identifying eGFR <30 ml/min/1.73m2 before outpatient CT. Methods: This retrospective study was performed at a health system that implemented an electronic screening form used by patients before outpatient CT encounters to report presence of dialysis, cancer-treating medications, kidney disease, prior kidney surgery, diabetes mellitus treated with medication, hypertensiontreated with medication, and multiple myeloma. Patients with any risk factor were required to undergo eGFR testing before CT. Of 44,708 patients completing the form from June 1, 2020 through February 28, 2021, 10,256 patients (5315 men, 4941 women; mean age, 66.8±11.9 years) underwent eGFR testing on date of CT. Multivariable regression analysis for predicting reduced eGFR was performed. Findings were compared with theoretical approach using ACR/NKF criteria. Results: Same-day testing yielded eGFR <30 mL/min/1.73m2 in 1.4% (144/10,256) of patients. Only significant independent predictors of low eGFR were dialysis [odds ratio (OR)= 203.30], kidney disease (OR=12.55), and diabetes mellitus treated with medication (OR=2.44). If following ACR/NKF criteria [only kidney disease (defined as dialysis, kidney disease, or prior kidney surgery) as trigger for eGFR testing], patients requiring testing would have decreased by 89.6% from 10,256 to 1059, yield woul have increased to 7.1% (76/1059), and 47.2% (68/144) of patiens with low eGFR would have been missed. If following ACR/NKF criteria but considering diabetes mellitus as a required rather than optional criterion, patients requiring testing would have decreased by 77.1% to 2353, yield would have increased to 4.0% (95/2353), and 34.0% (49/144) with low eGFR would have been missed. Conclusion: Using patient-reported risk factors resulted in frequent eGFR testing but low yield of low eGFR. Commonly applied risk factors were not independently associated with low eGFR. Clinical Impact: Application of ACR/NKF criteria would substantially reduce eGFR testing, though miss patients with renal dysfunction. The statement should consider omitting kidney surgery as trigger for eGFR testing and treating diabetes mellitus as a required trigger.