title: Risk of nephrogenic systemic fibrosis is low in patients with chronic liver disease exposed to gadolinium-based contrast agents.
abstract: OBJECTIVE
  To determine the risk of nephrogenic systemic fibrosis (NSF) in a cohort of patients with chronic liver disease.
  
  
  METHODS
  This retrospective, Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study was performed at a single tertiary liver center. The study cohort comprised 1167 patients with chronic liver disease followed in a liver clinic and exposed to gadolinium-based contrast agents (GBCAs) between February 2004 and October 2007. A retrospective review of medical records was performed. For each patient, data were collected on demographics, history of GBCA exposure, presence of purported risk factors for NSF, and histopathological evidence of NSF.
  
  
  RESULTS
  Of the 1167 patients with chronic liver disease, 58% (n = 678) had cirrhosis. The patients had a total of 2421 separate GBCA exposures. Fifty-five percent (n = 646) had a single exposure, 19% (n = 218) had two exposures, and 26% (n = 303) had three or more exposures. Seventy-two percent (n = 843) of patients had renal insufficiency, 25 patients (2.1%) had hepatorenal syndrome, 80 patients (6.8%) were in the perioperative liver transplant period, and 49 patients (4.2%) had one or more additional risk factors for NSF. None of the 1167 patients developed NSF.
  
  
  CONCLUSIONS
  Chronic liver disease does not appear to be a significant risk factor for NSF.
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, California, USA; Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Emmanuil
authors.initials: E
authors.lastname: Smorodinsky
authors.forename: David S
authors.initials: DS
authors.lastname: Ansdell
authors.forename: Zeke W
authors.initials: ZW
authors.lastname: Foster
authors.forename: Sameer M
authors.initials: SM
authors.lastname: Mazhar
authors.forename: Irene
authors.initials: I
authors.lastname: Cruite
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.forename: Sebastian B
authors.initials: SB
authors.lastname: Sugay
authors.forename: Gabriella
authors.initials: G
authors.lastname: Iussich
authors.forename: Masoud
authors.initials: M
authors.lastname: Shiehmorteza
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kono
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuo
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015984:Causality; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D003287:Contrast Media / Q000009:adverse effects; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: chronic liver disease; nephrogenic systemic fibrosis