Imaging in the Dialysis Patient: Contrast Agents in Patients on Dialysis

Abstract

Contrast media are used to enhance the structural and functional information that is provided by imaging methods. They are used particularly in conventional radiographic (X-ray) investigations, but are also used in magnetic resonance imaging (MRI) and increasingly in ultrasound (US). The water-soluble, iodinated, intravascular radiographic agents are commonly used, and in large doses. They are excreted almost exclusively by the kidney and may have nephrotoxic effects. The use of these agents in patients with renal impairment may potentially be problematic. In this article the chemical composition and pharmacokinetics of these contrast agents are reviewed, as are their potentially toxic effects on the heart, neural tissues, kidney, and endothelium. Their safety for use in the patient with end-stage renal disease (ESRD) and those on dialysis is discussed. This aspect is also addressed briefly for the contrast agents used to augment MRI and US.

Enhanced radiation damage caused by iodinated contrast agents during CT examination

“…First, individual sensitivities couldn't be ignored. To date, the use of lowosmolality ICA had not totally suppressed vasodilatation and intracellular dehydration [15], still causing some adverse reactions attributed to "allergy to iodine" [22]. Secondly, the use and the storage or preservation method of ICA might cause the instability of itself, resulting in a release of iodides I − and influencing the micronuclei yields [23], which could also manifest as the form of γH2AX-foci [24].…”

Stenosis detection in failing hemodialysis access fistulas and grafts: Comparison of color Doppler ultrasonography, contrast-enhanced magnetic resonance angiography, and digital subtraction angiography

“…The MR technique requires a venous puncture for contrast administration, whereas the Dialysis Outcome Quality Initiative guidelines indicate that puncture of peripheral veins should be avoided under the doctrine of venous preservation. 21 In addition, gadolinium may have some nephrotoxicity properties in patients with residual renal function, 22,23 and MRA is considerably more expensive than Doppler ultrasonography ($283 vs $80). The presence of contraindications for MR imaging is another drawback of this imaging modality: almost 10% of the patients had to be excluded from our study because they had contraindications to the MRA.…”

64-Slice MDCT Angiography of Upper Extremity in Assessment of Native Hemodialysis Access

“…6,9,14 The use of gadolinium contrast material was not an advantage over the iodinated contrast because the gadolinium contrast material may have some nephrotoxicity in impaired kidneys. 15,16 In general, most of the CE-MRA study used gadolinium in the range of 20 to 40 mL, 12,14 which resulted in renal toxicity in vitro study, 16 particularly in patients with renal insufficiency. Late complication of nephrogenic systemic fibrosis in using gadolinium compound was strongly associated with patients with chronic renal insufficiency.…”