Dialysis and Contrast Media

Contrast media-induced nephropathy remains an important cause of hospital-acquired acute renal failure. Pre-existing renal impairment, especially diabetic nephropathy and the dose of the contrast medium are major risk factors in the development of contrast nephropathy ( Morcos et al. 1999; Morcos 1998, 2004). It is generally agreed that if contrast medium injection is clinically necessary prophylactic measures should be used to reduce the risk ( Morcos et al. 2002). Prophylactic hemodialysis has been proposed to prevent contrast nephrotoxicity in patients with renal impairment, but has not obtained general acceptance. In addition, there is misunderstanding about whether intravascular contrast medium injection in patients on dialysis should be scheduled in relation to the time of the hemodialysis session ( Morcos et al. 2002). In this chapter, the use of hemodialysis and peritoneal dialysis in the elimination of water-soluble, iodinated or gadolinium-based contrast agents in patients with end-stage renal disease and the value of hemodialysis in preventing contrast media-induced nephrotoxicity in patients with pre-existing renal impairment will be discussed.