Effect of radio contrast media on residual renal function in peritoneal dialysis patients—a prospective study

Dittrich, Elisabeth; Puttinger, Heidi; Schillinger, Martin; Lang, Irene M.; Stefenelli, Thomas; Hörl, Walter H.; Vychytil, Andreas

doi:10.1093/ndt/gfi023

Cited by 62 publications

(35 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although some studies have found no change in RRF after radiocontrast dye (29,30), contrast should be avoided to the extent possible. If PD patients must undergo a radiocontrast study, they should be well hydrated (although, obviously not excessively so) and the lowest volume of an iso-osmotic or low-osmotic contrast agent should be used.…”

Section: Other Factorsmentioning

confidence: 95%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

The incidence and prevalence of ESRD in the United States continues to increase. Currently there are over 26,000 patients maintained on peritoneal dialysis. Mortality rates have fallen over the past several years, but long-term survival remains poor, with only 11% of peritoneal dialysis patients surviving past 10 years. Cardiovascular disease accounts for most deaths, and dialysis patients have many traditional and nontraditional cardiovascular risk factors. Lowering of these risk factors has not resulted in reduced cardiovascular morbidity and mortality in dialysis patients. Maneuvers to improve long-term peritoneal dialysis patient survival must therefore focus on modifiable risk factors including residual renal function, peritoneal membrane integrity, rate of infections, and peritoneal dialysis center size. This article reviews strategies for preserving residual renal function and peritoneal membrane integrity as well as strategies for reducing the rate of infections to enhance long-term survival in peritoneal dialysis patients.Clin J Am Soc Nephrol 5: 1123-1131, 2010. doi: 10.2215/CJN.04300709T he incidence and prevalence of ESRD continues to increase worldwide. In the United States alone there are over 480,000 patients on dialysis and the number of incident dialysis patients each year exceeds 100,000 (1). Peritoneal dialysis (PD) is an established treatment modality for patients with ESRD. Currently, 26,082 patients are maintained on PD in the United States (1). Mortality rates in ESRD patients have declined significantly over the past 20 years, but longterm survival remains poor, with the overall survival for all dialysis patients [hemodialysis (HD) and PD] being only 11%. These data were not censored for modality change, the effect of which is difficult to gauge. On a proportional basis, a greater percentage of PD than HD patients switch modality; however, in absolute numbers, more HD patients transition to PD than the reverse. Nevertheless, the overall adjusted probability of survival in incident PD patients at 1 year is 86.8%, but only 11.3% at 10 years (1). The reason for this dramatic decrease in patient survival over time is multifactorial and depends on several patient and dialysis center factors.There are several patient factors that affect survival on PD, most of which are nonmodifiable. Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%). The genetics of the patient may be another nonmodifiable determinant of CVD. For example, a recent study of 1200 HD patients found an increased risk of CVD in patients with a specific complemen...

show abstract

Section: Other Factorsmentioning

confidence: 95%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…It has been reported that the use of approximately 100 mL dose of contrast media did not decrease residual kidney function in patients undergoing peritoneal dialysis with a creatinine clearance (CCr) of 4.4-7.0 mL/min/1.73 m 2 compared with the control group [46,47]. Urine volume had a range of 1,300-1,800 mL/ day in many patients enrolled in these studies.…”

Section: Level Of Evidence: Iva Grade Of Recommendation: Not Applicablementioning

confidence: 96%

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

et al. 2013

View full text Add to dashboard Cite

“…2 ml/min/1.73 m 2 , both occurring within two 3-monthly measurements and persistent thereafter. These cut-off values were chosen by consensus applying the Delphi technique on clinical relevance and the basis of data from previous studies [3,4,9,10,18,20] . The Delphi technique is a structured, written consensus process whereby documents are anonymously circulated within an expert group, with each round of the document incorporating the feedback from the previous round until consensus has been achieved.…”

Section: Definitions Of Rrf Decline and Variablesmentioning

confidence: 99%

“…neutral, bicarbonate-buffered dialysis solutions with low levels of glucose degradation products [13,14] , prevention of peritonitis, and avoiding the use of nephrotoxic drugs and radiocontrast media [15][16][17][18] , although the effects of these protective strategies to preserve RRF are not undisputed [18][19][20][21][22][23][24][25] .…”

mentioning

confidence: 99%

“…However, radiocontrast, nephrotoxic drugs, hypotension and other factors exert acute, adverse effects on renal function with an abrupt RRF decline. Thirdly, those studies looking at rapidly declining RRF have limited the analysis to single risk factors disregarding other potentially important factors [8,10,11,18,20] . Finally, when analyzing risk factors of rapid RRF decline, the effect of lead-time bias needs to be taken into account which was only done in a minority of previous studies [10,11] .…”

mentioning

confidence: 99%

See 1 more Smart Citation

Definition and Risk Factors of Rapidly Declining Residual Renal Function in Peritoneal Dialysis: An Observational Study

Herget–Rosenthal

Ostrowski²,

Kribben³

2012

Kidney Blood Press Res

View full text Add to dashboard Cite

Background: It is critical to preserve residual renal function (RRF) in peritoneal dialysis (PD), as RRF is associated with lower morbidity and mortality. There is no uniform definition of RRF, and rapidly declining RRF has rarely been studied and predominately limited to single factor analysis and not corrected for lead-time bias. Methods: An observational study in 71 incident PD patients. RRF was defined as urine output (UO) ≥500 ml/day and renal glomerular filtration rate (rGFR) ≥2 ml/min/1.73 m², rapid declining RRF as UO <500 ml/day and rGFR <2 ml/min/1.73 m² occurring within 6 months which were separately evaluated. Independent risk factors associated with rapid RRF decline were identified while correcting for lead-time bias. Results: RRF declined rapidly by both definitions in 65% patients 2.5 years after PD start. Both definitions of RRF decline were consistent in 96%. Nephrotoxic drugs, renal transplant failure and absent angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were independent risk factors associated with rapidly declining RRF defined both by definitions, intravascular radiocontrast additionally for UO decline. Conclusions: Most PD patients demonstrated rapid RRF decline, independent of its definition. Both definitions are highly consistent and interchangeable. Nephrotoxic drugs and radiocontrast were identified as risk factors of acute, absent ACEI or ARB, and renal transplant failure of chronic renal injury.

show abstract

Effect of radio contrast media on residual renal function in peritoneal dialysis patients—a prospective study

Abstract: Administration of iopromide did not lead to a persistent decline of residual renal function in CAPD patients. Nevertheless, non-ionic hypo-osmolar CM should be given to these patients with the lowest possible dose and only if there is a real clinical indication.

Cited by 62 publications

References 19 publications

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Definition and Risk Factors of Rapidly Declining Residual Renal Function in Peritoneal Dialysis: An Observational Study

Contact Info

Product

Resources

About