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  • Title: Gadolinium-containing magnetic resonance imaging contrast and nephrogenic systemic fibrosis: a case-control study.
    Author: Kallen AJ, Jhung MA, Cheng S, Hess T, Turabelidze G, Abramova L, Arduino M, Guarner J, Pollack B, Saab G, Patel PR.
    Journal: Am J Kidney Dis; 2008 Jun; 51(6):966-75. PubMed ID: 18501784.
    Abstract:
    BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report. STUDY DESIGN: Matched case-control. SETTING & PARTICIPANTS: Dialysis patients with and without a diagnosis of NSF treated at an academic medical center. PREDICTOR: Exposure to gadolinium-based contrast. OUTCOMES & MEASUREMENTS: Laboratory and clinical characteristics of NSF. RESULTS: 19 of 28 cases identified at the hospital from December 2002 to August 2006 met inclusion criteria and were matched to 57 controls. In univariate analysis, receipt of gadolinium-containing MRI contrast in the preceding year (odds ratio [OR], 7.99; 95% confidence interval, 2.22 to 28.8) was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure (OR, 9.83; 95% confidence interval, 2.09 to 46.2) was associated more strongly with NSF than gadoversetamide (OR, 1.82; 95% confidence interval, 0.33 to 10.2). Although not statistically significant, cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding 6 months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls. In multivariable analysis, gadolinium contrast exposure (OR, 8.97; 95% confidence interval, 1.28 to 63.0) remained significantly associated with NSF. LIMITATIONS: Retrospective design, small sample size, inability to completely evaluate erythropoietin. CONCLUSIONS: Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.
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