Does hemodialysis prevent Contrast induced nephropathy?
The use of hemodialysis or hemofiltration for the prevention of Contrast induced nephropathy has been proposed to prevent Contrast induced nephropathy.
Although dialysis can remove the majority of the contrast media, a recent meta-analysis has failed to show that periprocedural dialysis decreases the risk for Contrast induced nephropathy.
One explanation for this finding is that hemodynamic changes in the renal vasculature occur within seconds of contrast administration, and subsequent histopathologic changes occur within 15 minutes.
It is logistically difficult to arrange for dialysis within minutes of contrast delivery, and there is significant associated risk involved with dialysis. Therefore, we do not recommend dialysis as prophylaxis from Contrast induced nephropathy.
Residual kidney function in dialysis patients still portends better outcomes in mortality; therefore, Contrast induced nephropathy can still have an adverse effect in dialysis patients.
Multiple studies suggest that when contrast media needs to be given to dialysis patients, emergent dialysis post-contrast administration is not needed and patients do well when the post-contrast dialysis is delayed for 24 to 48 hours.
The only exception may be in patients with severe volume overload or significantly reduced left ventricular function; in these patients, dialysis, shortly after contrast administration, may be advisable.