title: Gadolinium-containing magnetic resonance imaging contrast and nephrogenic systemic fibrosis: a case-control study.
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.
  
  
  METHODS
  Matched case-control.
  
  
  METHODS
  Dialysis patients with and without a diagnosis of NSF treated at an academic medical center.
  
  
  METHODS
  Exposure to gadolinium-based contrast.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection and Control of Infectious Diseases, Atlanta, GA, USA. akallen@cdc.gov
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jhung
authors.forename: Steven
authors.initials: S
authors.lastname: Cheng
authors.forename: Theresa
authors.initials: T
authors.lastname: Hess
authors.forename: George
authors.initials: G
authors.lastname: Turabelidze
authors.forename: Liana
authors.initials: L
authors.lastname: Abramova
authors.forename: Matthew
authors.initials: M
authors.lastname: Arduino
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Brian
authors.initials: B
authors.lastname: Pollack
authors.forename: Georges
authors.initials: G
authors.lastname: Saab
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000139:chemically induced; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064925:gadodiamide; D019786:Gadolinium DTPA; C112666:gadoversetamide