What are issues with contrast media (CM) administration in patients on dialysis?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In patients already on dialysis, the commonly cited issues with contrast administration include volume load and direct toxicity of contrast to the remaining nonfunctional nephrons and nonrenal tissues. These issues underlie the perceived need for emergent dialysis and contrast removal.

Rodby attempted to address these concerns, calculating that the administration of 100 mL of hyperosmolar contrast would move 265 mL of water from the intracellular to the extracellular compartment, resulting in an increase in extracellular volume by 365 mL. The increase in intravascular space would therefore be only a third, or 120 mL. Fluid shifts with low-osmolarity CM are even less. Rodby also found that extrarenal toxicity of CM was cited in mostly single case reports, and no objective evidence could be identified in three prospective studies. [52]


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