title: Prevalence of NSF following intravenous gadolinium-contrast media administration in dialysis patients with endstage renal disease.
abstract: OBJECTIVE
  To evaluate the prevalence of nephrogenic systemic fibrosis (NSF) in a patient population being at highest risk for developing this disease and to evaluate possible risk factors.
  
  
  METHODS
  The radiological records of 552 patients with ESRD being on hemodialysis (HD) or peritoneal dialysis (PD) were retrospectively reviewed to identify whether the patients underwent MR-examinations with or without intravenous administration of GBCA. In case of exposure to GBCA, the number of contrast injections, the benchmark and the cumulative doses of GBCA, and possible cofactors regarding pathogenesis of NSF were recorded. Diagnosis of NSF was confirmed either by deep skin biopsy or by review of medical and histopathological records. Data of NSF patients were compared with data of dialysis patients who did not develop NSF after MR-examinations.
  
  
  RESULTS
  146 dialysis patients underwent MRI without i.v.-administration of GBCA. No case of NSF was observed in this patient population. 195/552 patients proved to have a total number of 325 well-documented exposures to GBCA. Seven different types of GBCA were used during these MR-examinations. NSF prevalence rate was 1.6%. One patient died of NSF. Three different types of GBCA were involved in 6 NSF cases. 4/6 proved to be confounded cases. The cumulative dose of GBCA, history of thrombosis, recent surgery, and the combination of HD and PD proved to be significant cofactors for the development of NSF (p<.05). No significant difference regarding residual renal clearance (p=.898) and residual urine volume (p=.083) was found between NSF and non-NSF patients.
  
  
  CONCLUSIONS
  The prevalence of NSF proved to be much lower in this high risk patient group being exposed to GBCA compared to the literature. NSF was not observed in ESRD patients undergoing MRI without administration of GBCA. Our data support a positive association between cumulative dose of GBCA and development of NSF. No positive association was found between residual renal clearance and residual urine volume and NSF.
authors.affiliation: Department of Radiology, Medical University of Vienna, Vienna, Austria. gertraud.heinz@meduniwien.ac.at
authors.forename: Gertraud
authors.initials: G
authors.lastname: Heinz-Peer
authors.forename: Anita
authors.initials: A
authors.lastname: Neruda
authors.forename: Bruno
authors.initials: B
authors.lastname: Watschinger
authors.forename: Andreas
authors.initials: A
authors.lastname: Vychytil
authors.forename: Alexandra
authors.initials: A
authors.lastname: Geusau
authors.forename: Markus
authors.initials: M
authors.lastname: Haumer
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
mesh_terms: D000368:Aged; D001706:Biopsy; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D005682:Gadolinium