Does Urgent Dialysis After Contrast Really Work…Not Really

Scenario #1: Prophylactic dialysis in patients without ESRD

Medicine: “Hey we have a patient with CKD that is getting IV contrast for a procedure today and we are consulting you for dialysis afterwards”

Nephrology Fellow: “Huh, what are you talking about?”

Medicine: “Doesn’t prophylactic dialysis prevent contrast induced nephropathy?”

Redbeans: Let’s review some of the data.

Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmful.

Conclusion: The strategy of performing hemodialysis immediately after the administration of low-osmolality contrast media in all patients with a reduced renal function did not diminish the rate of complications, including radiocontrast nephropathy. 6 Days after dialysis there was no difference in the group that got hemodialysis and the group that didn’t.

Simultaneous hemodialysis during coronary angiography fails to prevent radiocontrast-induced nephropathy in chronic renal failure.

Conclusion: Simultaneous dialysis reduces AUC of contrast significantly, however, does not influence plasma peak concentration after angiography. Renal function and incidence of end-stage renal failure were not influenced by online-dialysis.

Short- and long-term renal outcomes of immediate prophylactic hemodialysis after cardiovascular catheterizations in patients with severe renal insufficiency.

Conclusion: This study confirmed that prophylactic HD immediately after contrast media administration in catheterizations failed to affect the short- and long-term renal and clinical outcomes even in patients with severe baseline renal insufficiency.

Scenario #2: Urgent dialysis in ESRD patient receiving contrast

ER: “Hey we have a patient with ESRD that gets dialysis MWF that received dialysis yesterday, that is going to get a CT scan that will need dialysis afterwards”

Nephrology Fellow: “Huh, what are you talking about?”

ER: “Don’t ESRD patients need dialysis after getting contrast?”

Redbeans: Let’s review the data.

Dialysis is not indicated immediately after administration of nonionic contrast agents in patients with end-stage renal disease treated by maintenance dialysis.

Conclusion: Although there is a theoretical risk there is no need for urgent dialysis after IV contrast administration in an ESRD patient on dialysis. Immediate postprocedural dialysis is unwarranted as a routine practice.

Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR). Dialysis and Contrast Median.

Conclusion: . There is no need to schedule the dialysis in relation to the injection of iodinated or MR contrast media or the injection of contrast agent in relation to the dialysis program. Hemodialysis does not protect poorly functioning kidneys against contrast-medium-induced nephrotoxicity.

2012 American College of Radiology’s Manual on Contrast Media

Conclusion: 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. With the usual being 100mL for a typical CT.

So if the patient is an ESRD patient there is the possibility that large amounts IV contrast can cause volume overload. So patients should be evaluated after contrasted studies if large amounts of contrast is used but other than that there is no indication for hemodialysis after or during contrast administration.

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