Is dialysis indicated immediately after administration of iodinated contrast agents in patients on haemodialysis?

Hamani, Abdelaziz; Petitclerc, Thierry; Jacobs, C.; Deray, Gilbert

doi:10.1093/ndt/13.4.1051

Cited by 22 publications

(16 citation statements)

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“…For patients receiving regular hemodialysis treatments who undergo radiocontrast studies, there is no evidence that immediate post-procedure dialysis to remove the contrast load is warranted or even beneficial [126][127][128].…”

Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

Contrast-induced nephropathy: pathogenesis and prevention

Cronin

2010

Pediatr Nephrol

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Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. Diagnostic and interventional cardiovascular procedures generate nearly half the cases. Elderly patients and those with chronic kidney disease, diabetes, and cardiovascular disease are at greatest risk. Procedure-related risk factors include large volumes of contrast and agents with a high osmolality. Renal medullary ischemia arising from an imbalance of local vasoconstrictive and vasodilatory influences coupled with increased demand for oxygen-driven sodium transport may be the key to its pathogenesis. Contrast agents may also have a direct cytotoxic effect that operates through the generation of reactive oxygen species. Pre- and post-procedure administration of normal saline, isotonic sodium bicarbonate, N-acetylcysteine, and a variety of other pharmacologic agents have been used to prevent or mitigate CIN. While normal saline is generally accepted as protective against CIN, uncertainty still surrounds the role of sodium bicarbonate and N-acetylcysteine. Dialytic therapies before, during, and after exposure to contrast have been tested with mixed results. Logistical and economic disincentives argue against these modalities.

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Section: Removal Of Contrast Media By Extracorporeal Therapiesmentioning

confidence: 99%

Contrast-induced nephropathy: pathogenesis and prevention

Cronin

2010

Pediatr Nephrol

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“…Three prospective studies attempted to determine whether exposure to contrast without postprocedure hemodialysis was harmful to patients with ESRD (16–18). Unfortunately the three studies involved a total of only 40 patients.…”

Section: Radiocontrast Removal With Hemodialysismentioning

confidence: 99%

“…The patients received contrast media for a scheduled study and were followed up for any possible side effects. None of the patients required dialysis before their next scheduled treatment and there were no more side effects than that seen in non‐ESRD control groups receiving similar doses of contrast (16–18). Despite the limited number of patients studied, these reports lend support to the lack of extra‐renal toxicity of contrast in patients maintained on hemodialysis.…”

Section: Radiocontrast Removal With Hemodialysismentioning

confidence: 99%

Preventing Complications of Radiographic Contrast Media: Is There a Role for Dialysis?

Rodby¹

2007

Seminars in Dialysis

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Nephrologists are often called upon to provide hemodialysis to remove radiographic contrast media in patients with chronic kidney disease (CKD)--usually but not exclusively, those with end-stage renal disease. The reasons for this request vary from concerns over the volume load associated with the administration of a hyperosmolar solution, to the renal and extra-renal toxicities of the contrast itself. Simple calculations demonstrate that the increase in extracellular volume after a typical contrast load is minimal. Data supporting the extra-renal toxicity of contrast in patients maintained on dialysis are lacking. Iodinated contrast agents have molecular weights of 700-1500. This relatively small size as well as their lack of protein binding makes them well suited for removal with extracorporeal renal replacement therapies. Thus, provision of hemodialysis immediately following a contrast load is often utilized in an attempt to prevent further renal damage in patients with advanced stages of CKD. A number of trials have failed to demonstrate that this maneuver is effective. Hemofiltration (HF) has been reported to decrease the risk of acute renal failure in patients with CKD receiving a contrast load, but the studies are methodologically flawed. Therefore, there is currently no sound basis for routinely recommending hemodialysis (or HF) in patients at high risk for contrast media-associated complications.

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“…These include hemodynamic or cardiovascular disturbances or central nervous system (CNS) reactions (20)(21)(22)(23)(24). The evidence for all this is hard to find in practice, as will be further discussed below (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Use Of Contrast Agents In the Presence Of Impaired Renal Funmentioning

confidence: 99%

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

Dawson

2002

Seminars in Dialysis

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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.

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Is dialysis indicated immediately after administration of iodinated contrast agents in patients on haemodialysis?

Cited by 22 publications

References 0 publications

Contrast-induced nephropathy: pathogenesis and prevention

Contrast-induced nephropathy: pathogenesis and prevention

Preventing Complications of Radiographic Contrast Media: Is There a Role for Dialysis?

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

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