Adonis Manzella
RECOMMENDATIONS
üThe
FDA recommends instituting prompt dialysis in patients with advanced
kidney dysfunction
who receive a GBCA. However this is not recommended by some other institutions, based on the fact that
in recent studies, dialysis did not prevent these patients from developing NSF (17,47,48).
üFor
patients undergoing peritoneal dialysis, ensure that patients have no periods
with a dry
abdomen (ie, peritoneal cavity contains no dialysate), and perform more
frequent manual exchanges or additional automated peritoneal dialysis cycles for at least 48
hours after administration.
DIALYSIS
üConsider hemodialysis for patients undergoing peritoneal dialysis who
may still have a functional vascular access for hemodialysis, for patients thought
to be at higher risk because of the dose used or prior recent exposure, and for those who
have other
risk factors, according to the judgment of the nephrologists (16).
üInitiating hemodialysis in patients
without vascular
access for the sole purpose of removing GBCA needs to be evaluated on an individual basis, and a risk-benefit
assessment
must be made regarding the need for GBCA administration versus the risks of developing NSF and/or
initiating dialysis
PREGNANCY
Following
intravenous administration to a pregnant patient, small amounts of GBCAs cross
the placenta and enter the fetal circulation. Subsequently, they are excreted
by the fetus into the
amniotic fluid, where they may remain and potentially dechelate, possibly exposing the developing fetus over a prolonged time. In light of recent concerns about NSF, this does not seem like a good
idea, especially in view of the relatively diminutive fetal renal function (21).