CONSULT ROUNDS: CONTRAST and ESRD/CKD

Few things to consider and take home what was talked about at the rounds
The discussion was of contrast load and dialysis patients or CKD patients. Is this a real concern or an old myth now in this era. It was a concern in the days when the dye used was more and the osmolarity of the dye was different. The three reasons perhaps a radiologist might ask you to consult is the concern for fluid overload with the contrast, to prevent residual function in the ESRD patient or to prevent the toxic effects on non renal tissue.

Few take home points and a nice article link.

1. With the common use of low osmolar contrast, the amount of actual contrast entering the ECF is very minimal and studies have disproven the use of it for fluid overload concerns.
2. In terms of residual renal function, it might be an issue with PD as the GFR obtained with PD is 7-8cc.min and the residual function plays a major role. But in HD patients, GFR even if they make urine is around 15-16ccmin making the residual renal function less likely a concern. Post procedure HD was at favor at one time but due to lack of data, it is not routinely recommended at this point.
3. In terms of extra renal side effects, there are few case reports suggesting that but a study of 40 patients showed that there is no major extra renal side effects from contrast in ESRD patients.

Check out this reference:
http://www.ncbi.nlm.nih.gov/pubmed/17244114