title: Low risk for nephrogenic systemic fibrosis in nondialysis patients who have chronic kidney disease and are investigated with gadolinium-enhanced magnetic resonance imaging.
abstract: OBJECTIVE
  During the past decade, nephrogenic systemic fibrosis (NSF) has been reported in patients who have severe renal impairment and have been exposed to a gadolinium (Gd)-based contrast agent during magnetic resonance imaging (MRI). As a result of positive reporting bias, many suitable patients with chronic kidney disease (CKD) are being denied a highly important form of investigation that can be safely undertaken. We analyzed the safety of Gd-MRI in patients with CKD and varying levels of estimated GFR (eGFR).
  
  
  METHODS
  We performed a retrospective analysis of 2053 unselected patients who had CKD and had received Gd-MRI between 1999 and 2009, so as to determine the risk for NSF related to level of CKD, nature of Gd preparation, and Gd dosage.
  
  
  RESULTS
  Overall, 2053 patients (63.5% men; mean age 60.6 +/- 15.7 years) had 2278 Gd-MRI scans; their mean eGFR was 40.7 +/- 23.7 ml/min. A total of 918 (44.7%) patients had stage 3, 491 (23.9%) had stage 4, and 117 (5.7%) had predialysis stage 5 CKD. No cases of NSF were identified during an average follow-up period of 28.6 +/- 18.2 months.
  
  
  CONCLUSIONS
  In this study, no patients developed NSF during extended follow-up, even after multiple Gd doses in some. Gd-MRI can be safely undertaken in the majority of patients with CKD, but caution is merited for dialysis patients and those with acute kidney injury, with relative caution for predialysis patients with stage 5 CKD.
authors.affiliation: Renal Department, Salford Royal Hospital, Stott Lane, Salford, Greater Manchester, M6 8HD, UK. tinachrys@doctors.org.uk
authors.forename: Constantina
authors.initials: C
authors.lastname: Chrysochou
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.forename: Aladdin E
authors.initials: AE
authors.lastname: Shurrab
authors.forename: Sayed
authors.initials: S
authors.lastname: Husain
authors.forename: Steven
authors.initials: S
authors.lastname: Moser
authors.forename: James
authors.initials: J
authors.lastname: Lay
authors.forename: Alan D
authors.initials: AD
authors.lastname: Salama
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects*; D004739:England; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D019786:Gadolinium DTPA / Q000009:adverse effects; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000009:adverse effects / Q000031:analogs & derivatives; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced*; D009942:Organometallic Compounds / Q000009:adverse effects; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; C090600:gadobutrol; D008536:Meglumine; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA; C072417:gadoterate meglumine; C109932:gadofosveset trisodium