Wednesday, January 2, 2013

IV contrast medium and ESRD

Radiologist: Please arrange for nephrology to comment on allowing us to give IV contrast to this dialysis patient. Right after the CT with IV contrast, dialysis has to be arranged.
Nephrology fellow: Why? the patient is anuric and what's the data on volume overload and needing of emergent dialysis after IV contrast dye.
Radiologist: Hmmm, good question. Lets look at it together.
Nephrology fellow: Look at this, its from the American College of Radiology Drug and Contrast Media 2012 update. 
"Renal Dialysis Patients and the Use of Iodinated Contrast Medium"
Patients with anuric end-stage chronic kidney disease can receive intravascular iodinated contrast medium without risk of further renal damage because their kidneys are no longer functioning. However, there is a theoretical risk of converting an oliguric dialysis patient to an anuric dialysis patient by exposing him or her to intravascular iodinated contrast medium. This remains speculative, as there are no conclusive outcome data in oliguric dialysis patients in this setting.
Patients receiving dialysis are also at theoretical risk from the osmotic load imposed by intravascular iodinated contrast medium because they cannot clear the excess intravascular volume. This osmotic load can theoretically result in pulmonary edema and anasarca. To mitigate this possible risk, contrast medium dosing should be as low as necessary to achieve a diagnostic result (as in all patients). However, complications were not observed in a study of dialysis patients who received intravascular nonionic iodinated contrast medium, though the number of patients was small.
Contrast agents are not protein-bound, have relatively low molecular weights, and are readily cleared by dialysis. Unless an unusually large volume of contrast medium is administered or there is substantial underlying cardiac dysfunction, there is no need for urgent dialysis after intravascular iodinated contrast medium administration.

Radiologist: I guess we rest that case.
Nephrology fellow: The guidelines by ACR have good information on MRI and CT scan and AKI and ESRD patients.

1 comment:

  1. We did a 10-Minute Rounds on this topic:


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