MO909: Dialysis After Contrast Agent Administration in Patients on Chronic Haemodialysis: It is a Common Clinical Practice?

Abstract

Abstract BACKGROUND AND AIMS Though the current dialysis population is characterized by a better survival, there is a greater burden of cardiovascular comorbidities. These two factors together expose patients to a greater number of diagnostic and therapeutic contrast tests. The European Society of Urogenital Radiology (ESUR) Guidelines on Contrast Agents 10.0 report that there is no need for urgent dialysis after intravascular iodinated contrast agent administration based on the results of the only study that addressed this problem, conducted in 10 patients by Younathan CM and published in the American Journal of Roentgenology in 1994. As far as the use of gadolinium contrast agent in dialysis patients, the recommendation is to try to perform the contrast agent injection prior to and close to the haemodialysis session, and an extra haemodialysis session to remove the contrast agent as soon as possible after it has been administered is recommended. It is now a well-known phenomenon that when there are low-level recommendations, the behaviour of nephrologists is not homogeneous. METHOD We have created a very simple survey (only 10 questions) to explore the behaviour of Italian nephrologists with respect to the administration of contrast agents in dialysis patients. The main information we wanted to obtain concerned the attitude towards the need for a dialysis session after the administration of a contrast agent (iodate or gadolinium), the timing respect to the contrast examination and the duration of the dialysis session. A total of 50 Italian nephrologists of 50 dialysis centres, respectively, responded to the questionnaire. The average number of chronic dialysis patients treated per single centre was 94 (median 80, interquartile range 46–135), meaning that these are representative of a population of at least 5000 haemodialysis patients. RESULTS After intravascular iodinated contrast agent, according to the ESUR guidelines 9 nephrologists (18%) do not perform an additional dialysis, while 34 nephrologists ( 68%) carry out an additional dialysis session (or organize the contrast examination to coincide with the scheduled dialysis session) (Fig. 1). A total of 32 nephrologists (64%) perform a specific dialysis session after magnetic resonance with gadolinium, as indicated in the ESUR guidelines (Fig. 2). In both cases (iodinated contrast agent or gadolinium), 28 nephrologists (56%) schedule the dialysis session within 4 h of the contrast examination (at least 2 h of treatment or complete dialysis session if possible). Remarkably, 10 nephrologists (20%) do not organize a specific dialysis section after MR with gadolinium (Fig. 2). CONCLUSION Our data confirm that in Italy, the majority of nephrologists still carry out an additional dialysis session after the administration of an iodinated contrast agent to avoid the potential risk of delay and adverse effects (intravascular volume expansion, pulmonary edema, depression of myocardial contractility and arrhythmias). Haemodialysis is an expensive procedure, in particular when performed as a nonscheduled emergent treatment at odd hours of the day or night. Further studies are needed to clarify this controversial point.