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Clearance of iopamidol, a non-ionic contrast medium, by CAPD in patients with end-stage renal failure

P. K. Donnelly, BSc, MD, FRCS N. Burwell, RGN A. McBurney, BSc, MPhil, PhD ^* J. W. Ward, BPharm, MBChB, FRCP J. Walls, MBBS, FRCP and E. M. Watkin, MBBS, FRCR, DMRD

Department of Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK ^* Department of Chemical Pathology, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK Department of Clinical Pharmacology, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK Department of Nephrology, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK Department of Radiology, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK

In normal healthy subjects radiographic contrast media are cleared by the kidneys with a half-life of approximately 2 h and a total body clearance of 8 1/h. The mechanism of contrast clearance has not been previously investigated in chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A study was undertaken to investigate the pharmacokinetics of a non-ionic water soluble radiographic contrast medium (iopamidol) in 10 patients stabilized on CAPD. All patients (eight male, two female) aged 22–68 years (median 53 years) had injection of 30 ml of iopamidol 300 via a forearm vein to investigate subclavian vein patency following previous cannulation for haemodialysis. Venous blood samples, CAPD dialysate and urine were collected for seven days post injection. The mean plasma half-life was 37.9 h (SD 10.6) (range 24.1–57.2 h) for the CAPD patients and was greatly prolonged in comparison to healthy subjects. The total body clearance of iopamidol was also greatly reduced (0.377 1/h). CAPD removed an average of 53.6% of the administered dose (range 36.3–80.8%) whilst an average of 26.9% was excreted in the urine (range 1.3–56.3%). The combined renal and dialysate clearance was up to 93% of the administered dose over the period of the study. There is therefore some evidence for a small extra renal clearance of iopamidol in end-stage renal failure patients. This study has shown for the first time that patients with end-stage renal failure undergoing CAPD have significantly delayed elimination of contrast medium. This should be taken into consideration when extensive or prolonged investigations using contrast medium are proposed.

Key Words: Iopamidol • Non-ionic contrast • Clearance • Continuous ambulatory peritoneal dialysis

Received for publication February 12, 1992. Revision received June 4, 1992. Accepted for publication July 16, 1992.