Mythbuster: Urgent dialysis following IV contrast?

Have you ever had to promise the radiologist that you would arrange emergent dialysis for your end-stage renal disease (ESRD) patient after receiving IV contrast?

This myth is even perpetuated in the field of nursing. In fact, what prompted this post was overhearing this very topic discussed between a nurse and a recent graduate nurse trainee.

Although there is no supportive data, two theoretical risks have been suggested:

1. An oliguric dialysis patient could progress to an anuric state after IV iodinated contrast administration.
2. The osmotic load from IV contrast could result in pulmonary edema and anasarca in a dialysis patient unable to clear the excess volume.

Mythbuster

Despite the theoretical concerns, there is no need for urgent dialysis after IV contrast administration in an ESRD patient on chronic dialysis. The patient should be able to wait until their next scheduled dialysis session. In fact, the 2016 American College of Radiology’s Manual on Contrast Media states, “Unless an unusually large volume of contrast medium is administered or there is substantial underlying cardiac dysfunction, there is no need for urgent dialysis after intravascular iodinated contrast medium administration.”

As an FYI, the average amount of contrast volume infused for a typical CT scan is around 100 mL.

There you have it, although I’m sure you already knew (or at least suspected).

For a nephrologist’s perspective, the Renal Fellow Network blog has a great post on this topic as well: http://renalfellow.blogspot.com/2009/08/prophylactic-hemodialysis-for-iv.html

References

• Younathan CM, et al. Dialysis is not indicated immediately after administration of nonionic contrast agents in patients with end-stage renal disease treated by maintenance dialysis. AJR Am J Roentgenol 1994;163(4):969-71. PMID 8092045
• Morcos SK, et al., and members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR). Dialysis and Contrast Media. Eur Radiol 2002;12(12):3026-30. PMID 12439587

Author information

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules and EM Pharm Pearls Series
Attending Pharmacist, EM and Toxicology, MGH
Associate Professor of EM, Division of Medical Toxicology, Harvard Medical School

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