Sinsakul Marvin, Ali Amjad
Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 60607, USA.
Semin Dial. 2004 Jan-Feb;17(1):53-6. doi: 10.1111/j.1525-139x.2004.17114.x.
Patients with end-stage renal disease (ESRD) are at risk of prolonged radiation exposure during therapy with radioactive iodine (131I) because it is normally renally excreted. However, 131I is dialyzable and exposure can be monitored with a standard Geiger counter during dialysis. We present two cases of thyroid carcinoma in patients with ESRD who were treated successfully with 131I while continuing chronic hemodialysis (HD). In each case, single HD treatments of 3 and 4 hours performed approximately 20 hours after the administration of 131I resulted in an 80% and 70% reduction in total body radiation levels, respectively. In both cases, Geiger counter measurements after HD following 131I administration revealed levels less than 3 mR/hr, allowing safe discharge from the hospital in a timely manner. All contaminated waste was disposed of by the hospital's Department of Radiation Safety. Postdialysis monitoring revealed no residual radiation contamination of the HD machine or radiation exposure to the dialysis staff. Hemodialyzer reuse was suspended until monitoring demonstrated no appreciable evidence of radioactivity in these spent supplies. HD is a critical aspect in the treatment of patients with ESRD receiving 131I and can safely be administered with close planning between the HD staff and the staff of radiation safety.
终末期肾病（ESRD）患者在接受放射性碘（¹³¹I）治疗期间有受到长时间辐射暴露的风险，因为¹³¹I通常通过肾脏排泄。然而，¹³¹I可通过透析清除，并且在透析期间可用标准盖革计数器监测辐射暴露情况。我们报告了两例ESRD合并甲状腺癌患者，他们在继续进行慢性血液透析（HD）的同时成功接受了¹³¹I治疗。在每例患者中，¹³¹I给药后约20小时进行3小时和4小时的单次HD治疗，分别使全身辐射水平降低了80%和70%。在这两例患者中，¹³¹I给药后HD后的盖革计数器测量显示水平低于3 mR/hr，从而能够及时安全出院。所有受污染废物均由医院辐射安全部门处理。透析后监测显示HD机器没有残留辐射污染，透析工作人员也没有受到辐射暴露。在监测表明这些用过的耗材没有明显放射性证据之前，暂停血液透析器复用。HD是接受¹³¹I治疗的ESRD患者治疗的关键环节，在HD工作人员和辐射安全工作人员之间进行密切规划的情况下可以安全进行。
