Large sample of nephrogenic systemic fibrosis cases from a single institution.
OBJECTIVE
To estimate and stratify the risk of development of nephrogenic systemic fibrosis (NSF) in well-defined at-risk subpopulations from a large single institution, and to perform a single-institution case series study of patients with biopsy-proven NSF.


METHODS
Retrospective cohort of patients exposed to gadolinium-based contrast agents (GBCAs) at a single institution during an 8-year period (January 1, 1999, to December 31, 2006), and a case series study of patients with biopsy-proven NSF.


METHODS
A primary, secondary, and tertiary health care center that treated more than 2.2 million outpatients and had 135 000 hospital admissions in 2007. Patients A total of 94 917 patients exposed to GBCAs; patients at risk for NSF (3779 patients on hemodialysis, 1694 patients with renal transplants, and 717 patients with liver transplants, a well-defined subgroup that includes patients at risk for reduced renal function); and 61 patients with a clinical diagnosis of NSF.


METHODS
Risk estimate for NSF.


RESULTS
The risk of development of NSF is 1.0% for patients who undergo hemodialysis (8 of 827), 0.8% for patients with renal transplantation (4 of 527), and 0% for patients with liver transplantation at our institution (0 of 327).


CONCLUSIONS
Despite the limitations, this study, which reviewed a large number of patients who underwent intravascular GBCA injections, demonstrates a 77-fold higher risk of NSF among patients who undergo hemodialysis and a 69-fold higher risk in patients with renal transplantation. This increased risk is thought to be associated with poor clearance of most GBCAs.
Lee
Christine U
CU
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. lee.christine@mayo.edu
Wood
Christina M
CM
Hesley
Gina K
GK
Leung
Nelson
N
Bridges
Mellena D
MD
Lund
Jeffrey T
JT
Lee
Peter U
PU
Pittelkow
Mark R
MR
D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology* / Q000628:therapy; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D017678:Sex Distribution
D019786:Gadolinium DTPA