SRS266 - Management of AKI in vascular patients: an evaluation against the ROUNDUP-26 guidelines

Abstract Background The ROUNDUP-26 protocol provides a structured approach to the recognition and management of AKI, with an emphasis on monitoring electrolytes, ruling out obstruction, clinical assessment, fluid management and involvement of renal physicians. The aim of this audit is to evaluate the management of AKI in vascular inpatients at a tertiary referral centre against the ROUNDUP-26 guidelines. Methods Retrospective review of vascular inpatients between December 2024 and February 2025 was performed, identifying patients with AKI using physical notes and electronic patient records. Data collected included demographics, details of diagnosis, investigations and procedures, stage of AKI, risk factors, the management of AKI according to ROUNDUP-26 guidelines and outcomes thereafter. Results Of 93 vascular inpatients, 27 AKI episodes were identified ,with a median age of 74 years (range 45–94 years). AKI occurred a median of 3 days after admission (range 0–55 days); 74% were Stage 1. Compliance with ROUNDUP-26 varied: repeat electrolyte analysis (70%), NEWS score (81%), prescriptions reviewed (56%), while urinalysis (41%) and excluding obstruction (41%) were less consistently performed. 48% (13/27 episodes) had documented complications, including one requirement for dialysis. All seven ROUNDUP steps were completed in only 33% (9/27) of episodes, of which 55% (5/9 episodes) led to complications. AKI resolved in 78% of cases. Four cases (16%) were associated with delayed discharge. Conclusions Compliance with ROUNDUP26 was variable, with key omissions in urinalysis and ruling out post-renal AKI. Despite high complication rates, most AKIs resolved. These findings support targeted interventions to improve adherence and raise departmental awareness.