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Elimination of Contrast Agent Gadobutrol with Sustained Low Efficiency Daily Dialysis Compared to Intermittent
Hanno Bunz1,2,3, Otto Tschritter4, Michael Haap5
1Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany, hanno.bunz@med.uni-tuebingen.de.
Insights
Sustained low efficiency daily dialysis (SLEDD) effectively removes gadolinium-based contrast agents (GBCAs) in intensive care unit patients, similar to intermittent hemodialysis (iHD). This study demonstrates SLEDD
Area of Science:
- Nephrology
- Radiology
- Critical Care Medicine
Background:
- Gadolinium-based contrast agents (GBCAs) can pose toxic risks in patients with renal failure.
- Intermittent hemodialysis (iHD) is established for GBCA removal.
- Efficacy of sustained low efficiency daily dialysis (SLEDD) for GBCA removal is unknown, particularly in intensive care unit (ICU) settings.
Purpose of the Study:
- To compare the efficacy of SLEDD versus iHD in eliminating the GBCA gadobutrol.
- To assess the safety and effectiveness of SLEDD for GBCA removal in ICU patients.
Main Methods:
- A comparative study involving 6 ICU patients on SLEDD and 7 ward patients on iHD.
- Three dialysis sessions were administered to both groups over three consecutive days post-gadobutrol administration.
- Gadolinium (Gd) concentrations in blood, dialysate, and urine were measured using mass spectrometry to calculate elimination rates.
Main Results:
- Initial plasma Gd concentrations were comparable between SLEDD and iHD groups.
- After the first dialysis, Gd reduction was 67% for SLEDD and 83% for iHD (p=0.0083).
- Subsequent sessions showed similar Gd reduction rates (89-96% for SLEDD, 94-98% for iHD) and overall elimination (91% for SLEDD, 89% for iHD).
Conclusions:
- SLEDD demonstrates comparable efficacy to iHD in eliminating gadolinium.
- SLEDD is a safe and effective method for removing GBCAs in ICU patients requiring renal support.
Background:
In patients with renal failure, gadolinium-based contrast agents (GBCA) can be removed by intermittent hemodialysis (iHD) to prevent possible toxic effects. There is no data on the efficacy of GBCA removal via sustained low efficiency daily dialysis (SLEDD) which is mainly used in intensive care unit (ICU) patients.
Methods:
We compared the elimination of the GBCA gadobutrol in 6 ICU patients treated with SLEDD (6-12 h, 90 L dialysate) with 7 normal ward inpatients treated with iHD (4 h, dialysate flow 500 mL/min). Both groups received 3 dialysis sessions on 3 consecutive days starting after the application of gadobutrol. Blood samples were drawn before and after each session and total dialysate, as well as urine was collected. Gadolinium (Gd) concentrations were measured using mass spectrometry and eliminated Gd was calculated from dialysate and urine.
Results:
The initial mean plasma Gd concentration was 385 ± 183 µM for the iHD and 270 ± 97 µM for the SLEDD group, respectively (p > 0.05). The Gd-reduction rate after the first dialysis session was 83 ± 9 and 67 ± 9% for the iHD and the SLEDD groups, respectively (p = 0.0083). The Gd-reduction rate after the second and third dialysis was 94-98 and 89-96% for the iHD and the SLEDD groups (p > 0.05). The total eliminated Gd was 89 ± 14 and 91 ± 4% of the dose in the iHD and the SLEDD groups, respectively (p > 0.05). Gd dialyzer clearance was 95 ± 22 mL/min and 79 ± 19 mL/min for iHD and SLEDD, respectively (p > 0.05).
Conclusions:
Gd-elimination with SLEDD is equally effective as iHD and can be safely used to remove GBCA in ICU patients.
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