Incidence of nephrogenic systemic fibrosis at a large university hospital in Sweden.
OBJECTIVE
Nephrogenic systemic fibrosis (NSF) is a rare condition that may follow administration of gadolinium-based contrast media (Gd-CM) in patients with renal insufficiency. This study was initiated to determine the incidence of NSF at Skåne University Hospital, Malmö, in Sweden.


METHODS
During the period January 2001 to December 2008 10 650 patients underwent magnetic resonance imaging (MRI) examinations. The re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation was used to calculate the estimated glomerular filtration rate (eGFR). The 272 patients with an eGFR <30 ml/min/1.73 m2 who were given Gd-CM were selected for final analysis. A diagnosis of NSF or other dermatological diagnoses in the 272 patients was searched for in the database of the Departments of Dermatology and Pathology.


RESULTS
The 272 patients, of whom 26 patients were on dialysis, had undergone 406 MRI examinations with Gd-CM. Mean follow-up time was 3.9 (±2.7 SD) years. Assuming a mean body weight of 70 kg, the overall median dose of the 406 examinations with Gd-CM was 0.14 mmol/kg body weight (0.06, 0.34; 2.5-97.5 percentiles). In this retrospective study of patients with eGFR <30 ml/min/1.73 m(2), none developed NSF (the upper 95% confidence limit for zero cases of NSF in the 272 patients was 2.3%).


CONCLUSIONS
Although it is premature to claim that Gd-CM using the regimen employed in this institution is safe to use in all patients with eGFR <30 ml/min/1.73 m(2), the results.indicate that development of NSF is extremely uncommon.
Vascular Center, Skåne University Hospital, Malmö, Sweden. alaa.alhadad@gmail.com
Alaa
A
Alhadad
Gunnar
G
Sterner
Åke
Å
Svensson
Hussein
H
Alhadad
Peter
P
Leander
D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
D003287:Contrast Media; D005682:Gadolinium