Dialysis After Administration of Gadolinium?

Drug Therapy in Patients With Chronic Renal Failure by Dr. med. Bertram Hartmann, PD Dr. med. David Czock, Prof. Dr. med. Frieder Keller in volume 37/2010

In their comprehensive article, the authors present “special aspects of medication therapy in renal failure. For the suggested immediate hemodialysis after administration of gadolinium in patients with an eGFR <30 mL/min, a more differentiated perspective is required. The recommendation to follow gadolinium administration in an eGFR <30 mL/min with hemodialysis treatment relates primarily to patients who are already participating in a chronic dialysis program. To insert a central venous catheter in patients with an eGFR <30 mL/min particularly to eliminate gadolinium and to follow up with dialysis does not reflect current practice nor the recommendations.

In another section, the authors warn about prescribing metformin in patients with increasingly deteriorating renal function and recommend the DPP-IV-inhibitor sitagliptin for an eGFR <60 mL/min. They recommend halving the dose in patients with an eGFR <30 mL/min. According to product information, sitagliptin is not recommended in patients with an eGFR <50 mL/min (at least in Germany).

For completeness’s sake it should be mentioned that the “calcium phosphate product” is not acknowledged in the current KDIGO guidelines for chronic kidney disease—mineral and bone disorder. The individual serum measurements of calcium and phosphate should be interpreted together and used for guiding clinical treatment. The mathematical construct of a calcium phosphate product is not explicitly recommended any more.

I doubt whether calcium-free phosphate binders such as sevelamer or lanthanum should be used only in cases of intolerance or ineffectiveness. I also doubt whether a stepwise scheme exists for administering phosphate binders. Good quality studies have shown that the efficacy of phosphate binders is similar, whether they contain calcium or not. However, aluminum-free phosphate binders should be given only temporarily, according to current guidelines. And why lanthanum should be given only temporarily does not become clear from current scientific data and existing guidelines.

DOI: 10.3238/arztebl.2011.0113b

Dr. med. Fedai Özcan

Klinikum Dortmund gGmbH

Beurhausstr. 40

44137 Dortmund, Germany

Conflict of interest statement

The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Hartmann B, Czock D, Keller F: Drug therapy in patients with chronic renal failure. Dtsch Arztebl Int 2010; 107(37): 647–56.