在我當住院醫師時，慢性腎臟病或是已經規則透析患者做了有顯影劑的電腦斷層檢查一定要求要接著排洗腎一次。然而目前的證據顯示，除非使用了大量的顯影劑或是心臟功能很差，並不一定要立即排洗腎，醫療操作上和以往已然不同。
目前高雄長庚心臟科使用的是：low osmolarity non-ionic contrast。
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ACR Manual on Contrast Media
Version 10.3，2018
ACR Committee on Drugs and Contrast Media
Page 40
Renal Dialysis Patients and the Use of Iodinated Contrast Medium Patients with anuric end-stage chronic kidney disease who do not have a functioning transplant can receive intravascular iodinated contrast medium without risk of further renal damage because their kidneys are no longer functioning. However, there is a theoretical risk of converting an oliguric patient on dialysis to an anuric patient on dialysis by exposing him or her to intravascular iodinated contrast medium. This remains speculative, as there are no conclusive outcomes data in this setting.
Patients receiving dialysis are also at theoretical risk from the osmotic load imposed by intravascular iodinated contrast medium because they cannot readily clear the excess intravascular volume. This osmotic load can theoretically result in pulmonary edema and anasarca, an issue that may have been more significant in the past when high-osmolality IV contrast media were utilized. Complications were not observed in one study of patients on dialysis who received intravascular nonionic iodinated contrast medium [91], though the number of patients in that study was small. In patients at risk for fluid overload, low osmolality or isoosmolality contrast media should be employed with dosing as low as necessary to achieve a diagnostic result.
Most low-osmolality iodinated contrast media are not protein-bound, have relatively low molecular weights, and are readily cleared by dialysis. Unless an unusually large volume of contrast medium is administered, or there is substantial underlying cardiac dysfunction, there is no need for urgent dialysis after intravascular iodinated contrast medium administration [91].
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