Nurse-driven hydration protocols are widely used to prevent post-contrast acute kidney injury (PC-AKI) in adults receiving iodinated contrast for contrast-enhanced CT (CECT). We systematically synthesized randomized trials and implementation studies pertinent to nurse-coordinated or protocolized hydration around CECT. In high-quality randomized trials, withholding pre-CT hydration was non-inferior to sodium bicarbonate or saline hydration for stage-3 chronic kidney disease (CKD) patients (PC-AKI =2–3%) and avoided line-related adverse events and costs. Observational and service redesign studies showed that standardized, nurse-led outpatient regimens were operationally safe and reduced appointment postponements, without fluid-overload signal, and that electronic alerts plus outpatient pathways improved quality of care for PC-AKI risk after CT. One before–after CT cohort using IV plus guided oral hydration found no significant creatinine rise. Guideline and consensus statements now emphasize that IV contrast induced kidney injury risk is lower than previously thought; prophylactic IV isotonic saline is reserved for AKI or eGFR < 30 mL/min/1.73 m², with case-by-case consideration for eGFR 30–44. Nurse-driven protocols add safety checks, patient education, and workflow benefits; however, for most stage-3 CKD outpatients undergoing CECT, routine prehydration is not required.