Does Continuous Venovenous Hemodiafiltration Concomitant with Radiological Procedures Provide a Significant and Safe Removal of the Iodinated Contrast Ioversol?

Abstract

Background: The purpose of our study was to investigate whether continuous venovenous hemodiafiltration (CVVHDF) concomitant with radiological procedures (RxP) was feasible, well tolerated and could significantly remove iodinated contrast media (CM). Methods: 26 patients with various degrees of renal insufficiency who were submitted to RxP were included in the study. The CVVHDF session was started immediately before CM administration. All the patients were evaluated for feasibility and tolerability; furthermore a pharmacokinetic study was done on 12 patients to calculate the amount of CM eliminated. The baseline incidence of CM nephropathy was studied in 25 consecutive historical controls. Results: The CM administered was 208 ± 146 g; the fractional removal of CM was 9.2 ± 4.9% during RxP and 30.9 ± 20.7% during the whole CVVHDF session. Hemodynamic tolerance was excellent. The incidence of CM nephropathy in the experimental and control groups was 37 and 24%, respectively. Conclusions: CVVHDF during RxP is feasible and well tolerated but ioversol removal is modest. This fact together with the high incidence of renal function impairment, the complexity of the procedure and its intrinsic risks, and the large amount of resources needed discourage the routine use of CVVHDF as a prophylactic tool to avoid CM nephropathy.