Premium
Preventing Complications of Radiographic Contrast Media: Is There a Role for Dialysis?
Author(s) -
Rodby Roger A.
Publication year - 2007
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2007.00233.x
Subject(s) - medicine , hemodialysis , dialysis , intensive care medicine , kidney disease , extracorporeal , hemofiltration , contrast (vision) , intravascular volume status , chronic renal failure , hemodynamics , artificial intelligence , computer science
Abstract 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.