HEMODIALYSIS FOR ELIMINATION OF THE NONIONIC CONTRAST-MEDIUM IOHEXOL AFTER ANGIOGRAPHY IN PATIENTS WITH IMPAIRED RENAL-FUNCTION

We examined the kinetics of contrast agent elimination during hemodial ysis in 7 patients with end-stage renal disease on regular hemodialysi s treatment (group I) and in 13 patients with impaired renal function (serum creatinine 214-657 mu mol/l; group II). The nonionic agent iohe xol was administered at a dose of 0.4-4.5 g/kg and a 6-hour hemodialys is was performed with 1-18 h delay. This procedure removed 60-90% (mea n 77%) of the iohexol present in the circulation at the start of dialy sis treatment. The mean extraction ratio across the dialysis membrane was 0.47 and was inversely related to blood flow. The total clearance of iohexol was 70.4 +/- 24.6 ml/min and was very close to dialyzer cle arance, as estimated from blood flow and extraction ratio. The plasma iohexol level after dialysis was related to the dose administered, ioh exol clearance, and the patients' body weight. During peritoneal dialy sis (36-60 liters dialysis fluid), 43-72% of the iohexol dose was remo ved from the patients' circulation. In patients of group II no further impairment of the renal function (increase of serum creatinine) in co njunction with angiography was observed. We conclude that hemodialysis and peritoneal dialysis are effective methods for removal of iohexol. Our observations suggest also that accelerated elimination of contast media by prophylactic dialysis can be beneficial in preventing furthe r reduction in renal function after angiographic procedures in high-ri sk patients.