157 Dialysis Is Not Indicated Immediately After Contrast in End Stage Renal Disease Patients on Hemodialysis

Abstract

DIALYSIS IS NOT INDICATED IMMEDIATELY AFTER CONTRAST IN END STAGE RENAL DISEASE PATIENTS ON HEMODIALYSIS Sophie Kwok, Mamatha Chella, Beenu Singh, Anjali Acharya Albert Einstein College of Medicine (Jacobi Medical Center), Bronx, New York, United States. Contrast agents can cause renal injury and is associated with other complications, such as intravascular volume expansion and pulmonary edema. Contrast is removed efficiently by hemodialysis. Many radiologists encourage immediate dialysis after a procedure with contrast media because it may precipitate fluid overload, but when this risk becomes clinically significant is poorly understood. We undertook a retrospective chart review to determine if dialysis was required for pulmonary edema in patients with end stage renal disease on maintenance dialysis after administration of contrast media. We studied all patients who were on dialysis three times a week and received contrast procedures from January 2008 to November 2010. Only procedures requiring at least 50 ml of contrast were included. There were 104 radiographic studies (60 unique patients) that used intravascular contrast media. Five studies used ionic contrast medium (hypaque) and the remaining studies used non-ionic contrast media (omnipaque, visipaque). The studies were: two CT head, seven CT neck, 18 CT chest, 43 CT abdomen/pelvis, seven CT chest/abdomen/pelvis, one upper extremity CT, 11 angiographies of the lower extremities, eight cardiac catheterizations, and seven fistulograms. Average volume of contrast used was 117.2 ml (range 50 to 260 ml). After seven studies (6.7%), seven different patients were dialyzed for fluid overload earlier than their next scheduled dialysis; however, these patients were already in pulmonary edema prior to contrast administration. After three studies (2.9%), three different patients were dialyzed earlier because of hyperkalemia. None of the patients had post-procedural side effect of pulmonary edema that warranted dialysis before the next routinely scheduled session. The results of this study suggest that contrast agents may be given safely to patients with end stage renal disease on maintenance hemodialysis without the additional cost or inconvenience of emergent post-procedural dialysis.