Your patient has end-stage renal disease (ESRD) and is anuric on chronic hemodialysis (HD). He receives angiography while admitted for concern for ACS. Despite having his regularly scheduled HD the day prior and showing no signs of volume overload or metabolic disturbances after, he receives emergent HD post-procedure. Is this necessary or could he have just stayed on his usual HD schedule? A recent “Things We Do For No Reason” article in the Journal of Hospital Medicine addresses this question.
Highlights below:
– Main concerns for iodinated contrast material (ICM) in ESRD patients are reducing residual renal function (in patients that still make urine) and volume overload
– Newer contrast agents are low-osmolality and thought not to be directly toxic to the kidneys
– HD after contrast-exposure does not give a protective benefit in ESRD HD patients, anuric or not. Therefore, you can stick to the patient’s usual HD schedule and should not delay necessary contrast-studies in this population to schedule additional emergent HD afterwards
The following are the recommendations made by the authors:
– “Immediate post-procedural HD after ICM exposure in ESRD patients is not required.
– Do not delay vital diagnostic or therapeutic procedures requiring ICM in ESRD patients.
– The indication for HD is independent of contrast exposure in ESRD patients.”
Article:
Ninan, J, Reddy, S, Qureshi, F. Things We Do for No Reason: Emergent hemodialysis after intravascular iodinated contrast exposure in chronic hemodialysis patients. J Hosp Med. 2022; 17: 653- 656. doi:10.12788/jhm.3683