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Rappai J, Crabtree JH, Mancini A, Badugu SK, Kaushal A, Gellens ME. Compatibility and stability of non-ionic iodinated contrast media in peritoneal dialysis solution and safe practice considerations for CT peritoneography. ARCH ESP UROL 2022; 43:151-158. [PMID: 35505602 DOI: 10.1177/08968608221096562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computerised tomographic (CT) peritoneography is performed on peritoneal dialysis (PD) patients to identify peritoneal boundary defects, dialysate maldistributions and loculated fluid collections. Iodinated contrast media are added to dialysate and infused through the dialysis catheter, and CT images are obtained. Chemical compatibility of contrast media with dialysis solutions has not been studied. In some institutions, pharmacists charged with oversight of compounded sterile preparations have placed a moratorium on the use of contrast media-dialysate mixtures until compatibility data become available. This study was undertaken to examine the compatibility of non-ionic iodinated contrast agents added to PD solution for the performance of CT peritoneography. METHODS 100 mL of three non-ionic iodinated contrast agents, iopamidol 370 mgI/mL, iohexol 300 mgI/mL and iodixanol 320 mgI/mL, were mixed with 2 L 1.5% dextrose PD solution and stored at 2-8°C, 25°C and 40°C. Observations at predefined intervals were made over 5 days for visual appearance, turbidity, pH, drug concentration and chemical degradation. RESULTS Iopamidol, iohexol and iodixanol were stable for 5 days under study conditions. The contrast-dialysate mixture remained clear and colourless, no turbidity changes observed, pH and drug concentrations were stable and no increase in existing impurities or new impurities were detected. CONCLUSIONS The addition of commonly used non-ionic iodinated contrast agents to 1.5% dextrose dialysis solution is chemically stable, meeting the criteria set forth in the standards and guidelines of the US Pharmacopeia and the Institute of Safe Medication Practices. A protocol for performing CT peritoneography is recommended herein to facilitate patient safety and diagnostic reliability of the imaging study.
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Affiliation(s)
- Jayan Rappai
- Baxter Innovations and Business Solutions Pvt. Ltd, Whitefield, Bengaluru, Karnataka, India
| | - John H Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, CA, USA
| | - Ann Mancini
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Sudheer Kumar Badugu
- Baxter Innovations and Business Solutions Pvt. Ltd, Whitefield, Bengaluru, Karnataka, India
| | - Anuj Kaushal
- Baxter Innovations and Business Solutions Pvt. Ltd, Whitefield, Bengaluru, Karnataka, India
| | - Mary E Gellens
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
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Dong J, Li W, Shu J, Lv C, Gan L, Bai J. Tolerance of peritoneal and residual renal function to intraperitoneal gadolinium-based agents: An animal experimental study of magnetic resonance peritoneography. Semin Dial 2021; 35:258-263. [PMID: 34811817 DOI: 10.1111/sdi.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND MR (Magnetic resonance) peritoneography is sensible for continuous ambulatory peritoneal dialysis (CAPD)-related complications, which could offer excellent soft-tissue contrast and allows a multiplanar imaging evaluation of complications. However, there is no study about the optimal concentration of the gadolinium-based agents nor the side effects of gadolinium-based agents on peritoneum and residual renal function. METHOD Five different groups of uremic rats and two groups of normal rats were injected with a 40-ml mixture of peritoneal dialysate and gadolinium-based agents at varying concentrations prior to MR peritoneography. Thereafter, MR image obtained was evaluated by two experienced radiologists blinded to the concentrations. Peritoneal morphology and thickness of the uremic rats were also assessed using hematoxylin and eosin and Masson staining. Residual renal function was evaluated using serum creatinine levels and hematoxylin and eosin (HE) staining of pathological kidney sections. RESULTS AND CONCLUSION The gadolinium-based agents used in this experiment have no significant effect on residual renal function. There is no obvious difference in the image quality at the different gadolinium-based agents concentration. Due to the adverse effects of gadolinium-based agents in the previous studies, we suggest reducing the dose of gadolinium-based agents during MR peritoneography to the lowest limits.
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Affiliation(s)
- Jing Dong
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenlu Li
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Shu
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cheng Lv
- Department of Medical Imaging, Southwest Medical University, Luzhou, China
| | - Linwang Gan
- Department of Nephrology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiao Bai
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Matsuoka N, Yamaguchi M, Asai A, Kamiya K, Kinashi H, Katsuno T, Kobayashi T, Tamai H, Morinaga T, Obayashi T, Nakabayashi K, Koide S, Nakanishi M, Koyama K, Suzuki Y, Ishimoto T, Mizuno M, Ito Y. The effectiveness and safety of computed tomographic peritoneography and video-assisted thoracic surgery for hydrothorax in peritoneal dialysis patients: A retrospective cohort study in Japan. PLoS One 2020; 15:e0238602. [PMID: 32881941 PMCID: PMC7470296 DOI: 10.1371/journal.pone.0238602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. Methods Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. Results The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20–96 days). During follow-up (median, 26 months; IQR, 10–51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups, respectively, withdrew from PD (P = 0.021). There were no surgery-related complications or hydrothorax relapse in the surgical group. Conclusions This study demonstrated the effectiveness and safety of CT peritoneography and VATS for hydrothorax. This approach may be useful in hydrothorax cases to avoid early drop out of PD and continue PD in the long term. Further studies are warranted to confirm these results.
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Affiliation(s)
- Naoya Matsuoka
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- Department of Renal Transplant Surgery, Aichi Medical University, Nagakute, Japan
| | - Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Akimasa Asai
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Keisuke Kamiya
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University, Nagakute, Japan
| | - Hirofumi Tamai
- Department of Nephrology, Anjo-Kosei Hospital, Anjo, Japan
| | | | - Takaaki Obayashi
- Department of Nephrology, Narita Memorial Hospital, Toyohashi, Japan
| | | | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Michimasa Nakanishi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Mizuno
- Department of Nephrology and Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
- * E-mail:
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