Dialysis and iodinated contrast media

Contrast media are excreted mainly by glomerular filtration. There is thus, a significant correlation between both body and renal clearances of contrast media and glomerular filtration rate, and their renal excretion will be delayed in patients with renal insufficiency. Contrast media can be efficiently removed from blood by hemodialysis (HD). Since most contrast media are middle-sized molecules, the main factors potentially influencing their removal by HD are blood flow, membrane surface area, molecular size, transmembrane pressure, and dialysis time. Peritoneal dialysis is also effective in removing contrast agents from the body but takes longer than HD. Dialysis immediately after radiographic contrast studies has been suggested for two groups of patients. Those on chronic HD and those at very high risk for contrast nephropathy. Three studies have examined the necessity of immediate dialysis after intravascular injection of contrast media in chronic HD patients; the authors found no evidence that it is effective at preventing contrast nephropathy. The reasons why HD treatment was not beneficial in those three studies are not known. Perhaps, the rapid onset of renal injury after administration of contrast media is one answer. It is also possible that HD per se was nephrotoxic and might have offset the beneficial effect of the removal of contrast media. Marenzi et al. randomized 114 consecutive patients with chronic renal failure undergoing coronary interventions to either hemofiltration in an intensive care unit or isotonic saline hydration. The authors concluded that periprocedural hemofiltration given in an intensive care unit setting appears to be effective in preventing the deterioration of renal function due to contrast agent induced nephropathy and is associated with improved in-hospital and long term outcomes. The concentration of contrast media can effectively be reduced by HD and peritoneal dialysis. HD does not offer any protection against contrast media induced nephrotoxicity. Hemofiltration may decrease the risk of contrast induced nephropathy and have some long-term benefits, but additional studies are needed to better define the appropriate population for this treatment.