Assessment of Knowledge and Practice Gaps in the Prevention of Contrast-Associated Acute Kidney Injury Among Doctors of Multiple Specialties in a Tertiary Care Hospital: A Clinical Audit.

INTRODUCTION: Contrast-associated acute kidney injury (CA-AKI) is a common and potentially preventable cause of hospital-acquired acute kidney injury. International guidelines recommend risk assessment, appropriate hydration, medication review, and patient counseling to reduce its incidence. However, adherence to these recommendations in routine clinical practice remains uncertain. METHODS: A criterion-based clinical audit was conducted among 102 doctors from multiple specialties at the National Hospital of Sri Lanka. An anonymous online questionnaire assessed knowledge and self-reported practices against Kidney Disease Improving Global Outcomes (KDIGO) and European Society of Urogenital Radiology recommendations. Descriptive statistics evaluated compliance with predefined audit standards, while Kruskal-Wallis and Spearman rank correlation analyses explored differences among professional groups and the relationship between knowledge and clinical practice. RESULTS: The mean knowledge score was 3.61/4, with registrars achieving the highest mean score (3.79/4). Most participants correctly identified the KDIGO definition of CA-AKI (89.2%), the diagnostic timeframe (90.2%), and intravenous hydration as the primary preventive strategy (91.2%). However, important practice deficiencies were identified in medication review (angiotensin-converting enzyme inhibitor withholding, 50.0%), appropriate hydration strategies for patients with heart failure (44.1%), and routine patient counseling (61.8%). No significant correlation was observed between knowledge scores and counseling practice (Spearman's ρ = 0.004, p = 0.97). CONCLUSION: Although clinicians demonstrated good theoretical knowledge of CA-AKI prevention, substantial gaps in evidence-based clinical practice were identified. These findings support the implementation of standardized institutional protocols, targeted education, and repeat audit cycles to improve guideline adherence and enhance patient safety.