Dialysis after contrast in patients with ESRD?
Question: “We are going to need to admit them for dialysis if we give contrast, right?”
Ninan, 2022.
Key Points:
We currently use low-osmolality agents (ie: iohexol) that are not directly toxic to kidneys.
Anuric patients we don’t need to worry about AKI…they have no salvagable kidneys. For patients who still make urine, studies have shown that modern contrast does NOT cause a decrease in residual kidney function in these dialysis patients.
100 cc of contrast isn’t going to put your patient into florid volume overload and low osmolarity agents don’t really cause dramatic fluid shifts.
Studies have not associated low-osmolarity agents with cardiovascular effects like cardiac dysfunction or hypotension.
The benefits of radiocontrast exposure to make a diagnosis far outweigh the theoretical (basically non-existent) risk of kidney injury or complications from contrast in ESRD patients.
ACR 2018 Guidelines: an extra dialysis session or change in dialysis schedule is NOT necessary because we gave contrast.
Take-Away: The decision to perform dialysis should be made independent of whether or not the patient is going to receive contrast. Do not delay diagnostic procedures in ESRD patients. They can receive dialysis as scheduled unless there is another indication for dialysis.
Resources Cited:
Ninan, J., Reddy, S., & Qureshi, F. (2022). Things We Do for No Reason™: Emergent hemodialysis after intravascular iodinated contrast exposure in chronic hemodialysis patients. Journal of hospital medicine, 17(8), 653–656. [PubMed]
