title: Systemic gadolinium toxicity in patients with renal insufficiency and renal failure: retrospective analysis of an initial experience.
abstract: OBJECTIVE
  To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function.
  
  
  METHODS
  We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration.
  
  
  METHODS
  Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available.
  
  
  RESULTS
  The overall incidence of adverse events in the study group was 3.6%. No event was severe or life threatening--nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control group (13.8%).
  
  
  CONCLUSIONS
  On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.
authors.affiliation: Department of Diagnostic Radiology, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Arsenault
authors.forename: B F
authors.initials: BF
authors.lastname: King
authors.forename: J W
authors.initials: JW
authors.lastname: Marsh
authors.forename: J A
authors.initials: JA
authors.lastname: Goodman
authors.forename: A L
authors.initials: AL
authors.lastname: Weaver
authors.forename: C P
authors.initials: CP
authors.lastname: Wood
authors.forename: R L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003287:Contrast Media; D003404:Creatinine / Q000097:blood; D005260:Female; D005682:Gadolinium / Q000009:adverse effects* / Q000493:pharmacokinetics*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D003287:Contrast Media; D005682:Gadolinium; D003404:Creatinine