title: Risk of acute kidney injury after exposure to gadolinium-based contrast in patients with renal impairment.
abstract: OBJECTIVE
  Gadolinium-based contrast media (Gd-CM) are reported to induce acute kidney injury (AKI) in a high-risk population group at the usual dose for magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) examinations. We assessed gadolinium-induced nephropathy in patients with renal impairment who underwent MRI or MRA examinations, and evaluated the risk factors.
  
  
  METHODS
  In this retrospective study, 238 patients with baseline renal impairment, who received MRI or MRA examinations with Gd-CM, were recruited. After all other AKI causes-liver decompensation, severe heart failure, all kinds of shock, and severe sepsis-and patients on dialysis were excluded, 158 patients were enrolled. AKI was defined as a decrease in glomerular filtration rate (GFR) >10% of baseline data within 3 days after administration of Gd-CM. Regression analysis was used to find independent risk factors for gadolinium-induced AKI (Gd-AKI).
  
  
  RESULTS
  Twenty-six of the 158 patients (16.5%) developed Gd-AKI. There were no significant differences in gender, age, or baseline GFR between those who did and who did not develop AKI. Comorbid coronary artery disease, liver cirrhosis, diabetes mellitus, and hypertension were not significantly associated with the development of Gd-AKI. However, sepsis was an independent risk factor for Gd-AKI after multivariate regression analysis (adjusted odds ratio: 4.417; 95% confidence interval: 1.671-11.676, p = 0.03).
  
  
  CONCLUSIONS
  It is potential AKI after administration of Gd-CM under sepsis condition at the dose for MRI and MRA examinations in patients with renal impairment. It is important to identify high-risk patients and closely monitor renal function after administration of Gd-CM.
authors.affiliation: Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
authors.forename: Hsien-Yi
authors.initials: HY
authors.lastname: Wang
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Kan
authors.forename: Tsair-Wei
authors.initials: TW
authors.lastname: Chien
authors.forename: Ching-Yih
authors.initials: CY
authors.lastname: Lin
authors.forename: Shih-Bin
authors.initials: SB
authors.lastname: Su
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium