Risk of nephrogenic systemic fibrosis (NSF)

In this large cohort of 94,917 patients who received gadolinium-based contrast over an 8 year period, the risk of developing NSF was 1% among hemodialysis patients and 0.8% among renal transplant patients (abstract). Although retrospective, the large cohort study helps to quantify the risk of NSF among patients with significant renal insufficiency.

Prognosis of nursing home patients initiating dialysis

In this cohort of 3702 nursing home patients who initiated dialysis, 58% had died by 1 year, and only 13% had maintained their pre-dialysis level of function. Although this study did not have a control group, it is still valuable in it's assessment of the grim prognosis of nursing home patients at the time of initiation of dialysis (abstract)

Dialysis patients and recurrent GI bleeding

In this case-control study of dialysis and non-dialysis patients with UGI bleeding, all had endoscopic control of their bleeding, and received 3 days of IV PPI (40mg IV BID), then oral PPI (20mg qday) for 2 months. The rate of re-bleeding at 7 days was about the same in the 2 groups, but between 7-30 days, the dialysis group had significantly higher rates of re-bleeding (10% vs 0%). Higher PPI doses in dialysis patients at discharge may be necessary to reduce the intermediate risk of re-bleeding (abstract).

Harm of forced diuresis to prevent CIN

In this trial of 92 patients with creatinine >1.7 mg/dl undergoing cardiac catheterization, they were randomized to saline hydration, or euvolemic forced diuresis (with saline, mannitol, and furosemide). The forced diuresis group had a significantly higher rate of CIN (50% vs 28%). The same study did a meta-analysis (including 2 other studies with a total of 251 patients) and found the relative risk of harm of forced diuresis (compared to saline hydration) was 2.15 (CI 1.37 to 3.37). Forced diuresis to prevent CIN is harmful (abstract).

HCO3 bolus to prevent contrast nephropathy

In this randomized trial of 144 patients with mild renal insufficiency (creatinine 1.1-2.0) undergoing elective cardiac catheterization, they were randomized to a single 20meq HCO3 bolus before contrast, and all received hydration. The incidence of nephropathy within 3 days (25% or 0.5 increase from baseline creatinine) was significantly lower in the HCO3 group (1% vs 13%). A single HCO3 bolus before contrast (added to hydration) appears to be effective in reducing post-procedure nephropathy in patients with mild renal insufficiency (abstract).