Gadolinium-Based Agents Safe for MRI Use

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SAN DIEGO—Magnetic resonance imaging (MRI) using gadolinium-based contrast agents is safe in intensive care unit (ICU) patients at high risk for kidney injury, according to the results of a small retrospective study presented in poster format at the Society for Critical Care Medicine 2011 annual meeting.

Researchers at Emory University School of Medicine in Atlanta who studied 116 such patients who underwent MRI with a gadolinium-based contrast agent observed no decline in renal function or nephrogenic systemic fibrosis (NSF), a rare but serious disease involving fibrosis of joints, skin, eyes, and internal organs.

The form of gadolinium used was gadobenate dimeglumine (Multihance), which confers a low risk for NSF. Fourteen of the patients had a creatinine value greater than 1.5 mg/dL, including six with chronic renal failure.

“Finding methods of imaging with non-iodinated contrast is important for this population,” lead investigator Nicole Harlan, a medical student at Emory, told Renal & Urology News. “This is a good start to learn more about the renal safety of gadolinium, and we will be validating the data with a prospective study.”

The patients had a mean age of 53 years, 51% were female, and 44% were white. Fourteen had a creatinine clearance greater than 1.5 mg/dL. Six of these individuals had chronic renal failure whereas the rest had some acute renal insult while in the hospital. All had comorbidities, such as diabetes. Patients' average creatinine value upon entering the ICU was 1.22 mg/dL; this dropped to an average of 1.17 mg/dL two days later and 1.15 mg/dL after three days.

The analysis by Harlan and her colleagues showed that patients' creatinine clearance values did not decrease after the individuals underwent MRI with the gadolinium-based contrast agent, regardless of baseline creatinine clearance. After more than one year of follow-up, no cases of NSF were identified.

Matt Leavitt, MD, who was not involved in the study, said he would like to see the results of the prospective study before making any judgments about whether gadolinium is indeed not deleterious to renal health in these patients.

“I wouldn't walk away from this poster saying there's no risk in this population, but it's a potential starting point to determining what the level of risk actually is,” said Dr. Leavitt, Clinical Assistant Professor and Medical Director for Interventional Nephrology at the University of Michigan Medical School in Ann Arbor.

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