Low Risk for Nephrogenic Systemic Fibrosis in Nondialysis Patients Who Have Chronic Kidney Disease and Are Investigated with Gadolinium-Enhanced Magnetic Resonance Imaging
Open Access
- 1 March 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (3), 484-489
- https://doi.org/10.2215/cjn.06580909
Abstract
Background and objectives: During the past decade, nephrogenic systemic fibrosis (NSF) has been reported in patients who have severe renal impairment and have been exposed to a gadolinium (Gd)-based contrast agent during magnetic resonance imaging (MRI). As a result of positive reporting bias, many suitable patients with chronic kidney disease (CKD) are being denied a highly important form of investigation that can be safely undertaken. We analyzed the safety of Gd-MRI in patients with CKD and varying levels of estimated GFR (eGFR). Design, setting, participants, & measurements: We performed a retrospective analysis of 2053 unselected patients who had CKD and had received Gd-MRI between 1999 and 2009, so as to determine the risk for NSF related to level of CKD, nature of Gd preparation, and Gd dosage. Results: Overall, 2053 patients (63.5% men; mean age 60.6 ± 15.7 years) had 2278 Gd-MRI scans; their mean eGFR was 40.7 ± 23.7 ml/min. A total of 918 (44.7%) patients had stage 3, 491 (23.9%) had stage 4, and 117 (5.7%) had predialysis stage 5 CKD. No cases of NSF were identified during an average follow-up period of 28.6 ± 18.2 months. Conclusions: In this study, no patients developed NSF during extended follow-up, even after multiple Gd doses in some. Gd-MRI can be safely undertaken in the majority of patients with CKD, but caution is merited for dialysis patients and those with acute kidney injury, with relative caution for predialysis patients with stage 5 CKD.Keywords
This publication has 23 references indexed in Scilit:
- Prevalence of NSF following intravenous gadolinium-contrast media administration in dialysis patients with endstage renal diseaseEuropean Journal of Radiology, 2010
- Novel sorbents for removal of gadolinium-based contrast agents in sorbent dialysis and hemoperfusion: preventive approaches to nephrogenic systemic fibrosisNanomedicine: Nanotechnology, Biology and Medicine, 2010
- Nephrogenic systemic fibrosis with a spectrum of clinical and histopathological presentation: a disorder of aberrant dermal remodelingJournal of Cutaneous Pathology, 2009
- Revascularization versus Medical Therapy for Renal-Artery StenosisNew England Journal of Medicine, 2009
- Gadolinium-enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: Critical review of the literature and UK experienceJournal of Magnetic Resonance Imaging, 2009
- An epidemic outbreak of nephrogenic systemic fibrosis in a Danish hospitalEuropean Journal of Radiology, 2008
- High Prevalence of Nephrogenic Systemic Fibrosis in Chronic Renal Failure Patients Exposed to Gadodiamide, a Gadolinium-Containing Magnetic Resonance Contrast AgentInvestigative Radiology, 2008
- New Insights into Nephrogenic Systemic FibrosisJournal of the American Society of Nephrology, 2007
- ACR Guidance Document for Safe MR Practices: 2007American Journal of Roentgenology, 2007
- Nephrogenic Systemic Fibrosis Among Liver Transplant Recipients: A Single Institution Experience and Topic UpdateAmerican Journal of Transplantation, 2006