Scottish researchers have confirmed an association between gadolinium-based contrast agent use and development of nephrogenic systemic fibrosis (NSF) in patients with renal failure undergoing renal replacement therapy (RRT), according to a report in Radiology (2007; published online ahead of print).


The findings come from a retrospective study of 1,826 patients who underwent RRT for chronic renal failure (stage 5 CKD) between January 1, 2000 and July 1, 2006 at two Glasgow hospitals. During the study period, 421 patients (23.1%) underwent a total of 542 gadolinium-enhanced MR examinations. Fourteen of the 1,826 patients were diagnosed with NSF. Of the 14, 13 (93%) had undergone gadolinium-enhanced MR imaging compared with 408 (22%) of 1,812 patients without the condition. In addition, patients with NSF received a signfiicantly higher median cumulative dose of gadodiamide than their gadolinium-exposed counterparts without NSF (0.39 vs. 0.23 mmol/kg of body weight).

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The authors noted that many centers worldwide have accepted the link between gadolinium-based contrast agents and NSF and have changed practice prior to fulfillment of the Koch postulates of causation.


“As patient care is paramount,” the investigators wrote, “this is a reasonable course of action. If there is no alternative to the use of gadodiamide, the lowest diagnostic dose should be used and prompt dialysis after imaging may facilitate removal of gadodiamide.”


On the basis of their findings and other studies, the authors concluded that gadodiamide no longer should be considered as without risk for use in patients with advanced renal failure who are undergoing RRT.