Removal of contrast media by different extracorporeal treatments

Background. Although the capability poreal treatments after administration of contrast media to prevent radiocontrast-induced nephropathy is controver sial, haemodialysis is performed in many institutions after radiographic pr ocedures. There are conflicting reports on the efficacy of different dialys ers and treatment modalities to remove contrast media. Methods, We compared the contrast medium-removing ability of different extr acorporeal treatments in a randomized trial. Thirty-nine patients on chroni c renal-replacement therapy or with chronic renal failure were randomized t o receive low-flux haemodialysis (Low-HD, n=10), high-flux haemodialysis (H igh-HD, n=10), online haemodiafiltration (HDF, 10 litre substitution, n=10) and online haemofiltration(HF, 18 litre substitution, n=9) after administra tion of contrast medium during routine radiological procedures. Plasma conc entrations of contrast medium (iopromide or iomeprol) were measured by ener gy-dispersive X-ray fluorescence analysis. Results. The extraction ratio for contrast media was 0.64 +/-0.1 for Low HD (P<0.05 vs High-HD and vs HDF), 0.74<plus/minus>0.1 for High-HD (P<0.05 vs HF), 0.81<plus/minus>0.1 for HDF (P<0.05 vs HF), and 0.62<plus/minus>0.1 f or HF. Mean extracorporeal plasma clearances were 82 +/-2 for Low-HD (P<0.0 5 vs High-HD and vs HDF), 100<plus/minus>2 for High-HD, 115 +/-4 for HDF (P < 0.05 vs HF), and 86<plus/minus>5 ml/min for HF. Conclusions. We conclude that HDF and High-HD remove contrast media more ef fectively than Low-HD and HF during the time of each treatment session. How ever, whether this is also true for the overall elimination of contrast med ia by these different procedures needs to be addressed in future studies, b y a precise assessment of the drug time course after the session.