title: Safety of low volume iodinated contrast administration for arteriovenous fistula intervention in chronic kidney disease stage 4 or 5 utilizing a bicarbonate prophylaxis strategy.
abstract: Efforts to increase the number of functioning arteriovenous fistulas in chronic kidney disease (CKD) stages 4 and 5 have been impacted by concerns about the risk for contrast-induced nephropathy during diagnostic and interventional procedures for poorly developed fistulas. We conducted a prospective observational study of low volume iodinated contrast administration for fistulography and angioplasty in a CKD stage 4 and stage 5 population pretreated with a sodium bicarbonate protocol. Acute kidney injury was assessed by change in serum creatinine and urinary neutrophil-gelatinase associated lipocalcin (NGAL). Only 1/18 patients (5.5%) developed acute kidney injury as defined by change in serum creatinine 48 hours after contrast exposure. No patients demonstrated significant change in urinary NGAL at 3 or 48 hours after procedure, nor did any require acute initiation of dialysis. Fistulography alone, or with angioplasty, utilizing a low volume of iodinated contrast and sodium bicarbonate solution for prophylaxis, appears to be safe in the CKD stages 4 and 5 population.
authors.affiliation: Division of Nephrology, Maine Medical Center, Portland, Maine 04102, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eisenhart
authors.forename: Scott
authors.initials: S
authors.lastname: Benson
authors.forename: Patricia
authors.initials: P
authors.lastname: Lacombe
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: Robert
authors.initials: R
authors.lastname: Zimmerman
authors.forename: Brad
authors.initials: B
authors.lastname: Schimelman
authors.forename: Mark G
authors.initials: MG
authors.lastname: Parker
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control* / Q000652:urine; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001639:Bicarbonates / Q000627:therapeutic use*; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000628:therapy* / Q000652:urine; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D006435:Renal Dialysis / Q000379:methods*; D012720:Severity of Illness Index; D014283:Triiodobenzoic Acids / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
chemical_list: D001639:Bicarbonates; D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol