Patients on dialysis can receive IV contrast, but the fact that a patient is on dialysis should NOT be regarded as automatically allowing the administration IV contrast, because of several potential hazards, including:

  • In the setting of acute renal failure, where dialysis is being performed with the expectation of renal recovery, it may be inappropriate to administer a nephrotoxic agent that may jeopardize the reversal of renal impairment.
  • In the setting of chronic renal failure where patients are still producing a small amount of urine, the small amount of residual renal function could be imperiled by IV contrast, potentially increasing the required frequency of dialysis and hastening the complications of severe renal impairment – neither of which are trivial considerations. Patients with renal insufficiency who require only intermittent or occasional dialysis are at substantial risk for contrast media-induced nephrotoxicity with further worsening of their renal function. Alternative imaging studies not requiring contrast media should be strongly considered.
  • In either setting, the volume of IV contrast may add to fluid overload, potentially adding to circulatory compromise. The volumes of both oral and IV contrast should be included in the fluid intake of dialysis patients.


While these hazards of giving IV contrast to dialysis patients may be relatively small, these risks should be weighed against the likely diagnostic benefit of contrast administration. The Nephrology Service is readily available for consultation in cases where the risk/benefit assessment is complicated, and closely follows all hospitalized dialysis patients.

It should also be noted that the common belief that dialysis patients require early post-procedural dialysis is unsupported by clinical studies and expert guidelines [1, 2]. Dialysis pre-procedure may be desirable, particularly if a large dose of contrast is anticipated or in patients with heart failure.

Key Point

Patients on dialysis can receive IV contrast, and early post-procedural dialysis is NOT routinely required. However, the fact that a patient is on dialysis should NOT be regarded as automatically allowing the administration IV contrast. The Nephrology Service is readily available for consultation in problematic cases.

References

  1. Younathan CM, Kaude JV, Cook MD, Shaw GS, Peterson JC. 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: 969-71.
  2. Morcos SK, Thomsen HS, Webb JAW, and members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR). Dialysis and Contrast Media. Eur Radiol 2002; 12: 3026-3030.