Effect of Intravascular Iodinated Contrast Media on Natural Course of End-Stage Renal Disease Progression in Hemodialysis Patients: A Prospective Study

Abstract

We evaluated the impact of intravascular iodinated contrast medium on residual diuresis in hemodialyzed patients. Two groups of clinically stable hemodialyzed patients with residual diuresis minimally 500 ml of urine per day were studied. The patients from the first group were given iso-osmolal contrast agent iodixanol (Visipaque, GE Healthcare, United Kingdom) in concentration of iodine 320 mg/ml with osmolality 290 mOsm/kg of water during the endovascular procedure. The second control group was followed without contrast medium administered. Residual diuresis and residual renal excretory capacity expressed as 24-h calculated creatinine clearance were evaluated in the both groups after 6 months. The evaluated group included 42 patients who were given 99.3 ml of iodixanol in average (range, 60-180 ml). The control group included 45 patients. There was no statistically significant difference found between both groups in daily volume of urine (P = 0.855) and calculated clearance of creatinine (P = 0.573). We can conclude that residual diuresis is not significantly influenced by intravascular administration of iso-osmolal iodinated contrast agent (iodixanol) in range of volume from 60 to 180 ml in comparison to natural course of urinary output and residual renal function during end-stage renal disease. This result can help the nephrologist to decide which imaging method/contrast medium to use in dialyzed patients in current practice.

Frequency of Acute Kidney Injury Following Intravenous Contrast Medium Administration: A Systematic Review and Meta-Analysis

“…Of 1489 potentially eligible references, 19 (1.3%) ultimately proved eligible for review of the full article. Six additional studies were excluded from this analysis, because the investigators did not analyze AKI as defined by increases in SCr level (32)(33)(34)(35), they did not exclusively analyze patients who received IV contrast medium (36), or they did not exclusively examine CIN (37). The final number of included studies was 13 (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

Preservation of residual kidney function in hemodialysis patients: reviving an old concept

“…A recent study compared forty-two patients with ESRD on hemodialysis with urine volume > 0.6 L/day who received iodixanol to an age and urine volume-matched cohort of ESRD hemodialysis patients with no contrast exposure. At three months after contrast exposure there was a decline in urine volume in both groups with no statistically significant difference 89 . Similar findings have been noted in PD patients, where only a temporary decrease in RKF was noted after contrast exposure 90 .…”

Iodinated Contrast Media Can Induce Long-Lasting Oxidative Stress in Hemodialysis Patients

“…Nevertheless, most of physicians in practical field don't pay particular attention to these patients undergoing the procedure using contrast. Furthermore, Janousek, et al7 recently reported that residual renal function is not significantly influenced by intravascular administration of iso-osmolal iodinated contrast agent (iodixanol) in ESRD, and that its use in these patients is relatively safe and even more recommendable than magnetic resonance imaging with its potential risk of nephrogenic systemic fibrosis. In contrary to the above, however, we have seen that many dialysis patients experience fatigue, malaise, loss of appetite, and general prostration and they have even fear of retesting, after the procedure using iodinated contrast media such as computed tomography (CT) or angiogram.…”