C-reactive protein levels and clinical symptoms following gadolinium administration in hemodialysis patients.
BACKGROUND
Until recently, gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) has increasingly replaced iodinated contrast agent examinations in dialysis patients, although only limited data existed about the clinical safety of Gd contrast agents in these patients. Specific clinical adverse events (AEs), including nephrogenic systemic fibrosis, were linked to Gd exposure in dialysis patients. An inflammatory reaction or transmetallation may be involved.


METHODS
Secondary analysis of a 5-day observational study in a parent cardiovascular study with repetitive cardiac MRI (32 patients) and patients undergoing Gd-enhanced MRI for clinical indications (6 patients). Clinical information and samples were obtained according to parent protocol.


METHODS
Dialysis patients at a university-based dialysis unit.


METHODS
Gd-chelate complex. 37 of 38 patients underwent 64 MRI studies with Gd-diethylenetriamine penta-acetic acid (Gd-DTPA). 25 of these patients underwent additional MRI studies with gadobutrol (n = 10), 0.9% saline (n = 7), or both (n = 8), and 1 patient received gadobutrol only.


RESULTS
Clinical adverse events; C-reactive protein (CRP) levels on days 1, 3, and 5 after MRI; Gd levels in blood and urine after MRI.


RESULTS
CRP levels increased 10-fold on day 3 after MRI in 87% of MRI studies with Gd-DTPA (+59.3 +/- 57.9 mg/L [P < 0.001] versus -0.9 +/- 3.7 mg/L with gadobutrol versus -0.9 +/- 8.5 mg/L with 0.9% saline). 77 mild to moderate and 3 serious AEs were observed in 24 patients. CRP levels and adverse events did not correlate with Gd blood concentrations. CRP level increase or AEs were not observed after MRI with gadobutrol or 0.9% saline.


CONCLUSIONS
Observational study without randomization, risk of bias because of multiple MRI studies in a limited patient cohort.


CONCLUSIONS
Gd-DTPA, but not gadobutrol, induces an acute-phase reaction and clinical AEs in dialysis patients. Additional investigations have to analyze the underlying pathomechanism.
Schieren
Gisela
G
Department of Nephrology, University Hospital, Heinrich-Heine-University Düsseldorf, Germany. gisela.schieren@med.uni-duesseldorf.de
Tokmak
Faruk
F
Lefringhausen
Lutz
L
van Bracht
Mark
M
Perings
Christian
C
Willers
Reinhardt
R
Günsel
Andreas
A
Kemper
Fritz
F
Wiesmüller
Gerhard Andreas
GA
Rump
Lars Christian
LC
D002097:C-Reactive Protein / Q000032:analysis*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects*; D011446:Prospective Studies; D006435:Renal Dialysis
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D002097:C-Reactive Protein; D019786:Gadolinium DTPA