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.
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. lee.christine@mayo.edu
Christine U
CU
Lee
Christina M
CM
Wood
Gina K
GK
Hesley
Nelson
N
Leung
Mellena D
MD
Bridges
Jeffrey T
JT
Lund
Peter U
PU
Lee
Mark R
MR
Pittelkow
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