No need for immediate dialysis after administration of low-osmolarity contrast medium in patients undergoing hemodialysis

Takebayashi, Shigeo; Hatta, Hideo; Chiba, Tetsuo

doi:10.1053/ajkd.2000.8301

Cited by 11 publications

(7 citation statements)

References 3 publications

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“…This finding also demonstrates the robustness of the data. Fourth, we did not have information about the types of contrast media, which would have affected the outcomes because lower-osmolarity contrast media may not require immediate dialysis to avoid hemodynamic effects 24 . Nonetheless, the data were mainly derived from the use of less than 100 ml of contrast media, suggesting that our data showing the risk of using more than 200 ml of contrast media is meaningful.…”

Section: Discussionmentioning

confidence: 99%

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

Kuno

Numasawa

Shoji

et al. 2022

Sci Rep

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Toxicity resulting from retained contrast media may cause adverse cardiovascular outcomes (e.g., heart failure and cardiogenic shock) for dialysis patients. However, the association between the administered contrast volume and outcomes of dialysis patients after percutaneous coronary intervention (PCI) has not been sufficiently investigated. We evaluated 953 consecutive dialysis patients (age, 67.9 ± 9.9 years; 30.1% with acute coronary syndrome) who underwent PCI between September 2008 and March 2019. Patients were divided into two groups: those with a contrast volume ≥ 200 ml and those with a contrast volume < 200 ml. The cutoff was 200 ml because 100 ml increment of contrast volume is known to raise the risk of acute kidney injury, and 200 ml is more than the average volume used at most PCI centers. The primary endpoint was a composite of in-hospital death, post-PCI cardiogenic shock and post-PCI heart failure. A multivariable logistic regression model and smooth spline curve were constructed to assess the association between contrast volume and the primary endpoint. The median contrast volume was 157 ml (interquartile range, 115–210 ml). The overall primary endpoint incidence was 6.8% (N = 65). A contrast volume ≥ 200 ml was associated with a higher risk of the primary endpoint (odds ratio 2.91; 95% confidence interval 1.42–6.05; P = 0.004). The smooth spline curve demonstrated a linear relationship between the contrast volume and primary endpoint. In conclusions, the contrast volume was associated with adverse in-hospital outcomes of dialysis patients undergoing PCI. Attention should be focused on the contrast volume used for dialysis patients undergoing PCI.

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Section: Discussionmentioning

confidence: 99%

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

Kuno

Numasawa

Shoji

et al. 2022

Sci Rep

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“…The latter larger volume is still only approximately 2% of the total extracellular fluid volume, which puts matters into perspective. Even if high osmolality (seven times plasma) agents are used, the impact on body osmolality and fluid volumes, when distribution has occurred, may be expected to be negligible, as has indeed been found in practice (31,32). Similarly, in practice no significant cardiovascular or hemodynamic disturbances have been observed in ESRD patients (31,32,34) when low osmolality nonionic agents are used, especially if in more modest doses than those cited above for occasional complex interventional procedures, so there seems little cause for concern.…”

Section: Contrast Agents In Esrd Dialysis Patientsmentioning

confidence: 90%

“…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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“…Multiple studies have examined the issue of volume overload and the majority of studies did not show that IV contrast increases the risk of volume overload [ 26 , 27 ]. A group of investigators retrospectively reviewed outcomes of 1,287 ESRD patients receiving 100 ml of Iohexol for CT who also only received dialysis at usual scheduled times and did not receive any extra sessions after contrast [ 28 ]. None of the patients developed side effects that needed urgent dialysis.…”

Section: Question 10mentioning

confidence: 99%

Clinical pearls in hospital nephrology

Hamadah

Fülöp

Gharaibeh

2021

Journal of Community Hospital Internal Medicine Perspectives

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Hospitalized patients who have established kidney disease and those who have acute kidney injury in the hospital, along with patients with electrolyte disturbances tend to be some of the most complex to care for. Through working closely in nephrology consultation in the hospital with patients and providers, in both private and academic settings, we have come to encounter certain common presentations and recurrent themes that are worthy of emphasis, and of which a good understanding can translate into improved patient care. For the provider who works closely with such patients, many of these aspects are important to recognize and understand. In this review, we present 10 questions that address some of the highly relevant aspects of nephrology for the provider in the hospital. Through a MEDLINE database search, we reviewed the most pertinent studies as we then go through the explanation of management decisions in an evidence-based methodology with an up-to-date approach based on the current literature on the subject.

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No need for immediate dialysis after administration of low-osmolarity contrast medium in patients undergoing hemodialysis

Cited by 11 publications

References 3 publications

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

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

Clinical pearls in hospital nephrology

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