TY - JOUR
T1 - Gadolinium-Containing Magnetic Resonance Imaging Contrast and Nephrogenic Systemic Fibrosis
T2 - A Case-Control Study
AU - Kallen, Alexander J.
AU - Jhung, Michael A.
AU - Cheng, Steven
AU - Hess, Theresa
AU - Turabelidze, George
AU - Abramova, Liana
AU - Arduino, Matthew
AU - Guarner, Jeannette
AU - Pollack, Brian
AU - Saab, Georges
AU - Patel, Priti R.
PY - 2008/6
Y1 - 2008/6
N2 - Background: Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report. Study Design: Matched case-control. Setting & Participants: Dialysis patients with and without a diagnosis of NSF treated at an academic medical center. Predictor: Exposure to gadolinium-based contrast. Outcomes & Measurements: Laboratory and clinical characteristics of NSF. Results: 19 of 28 cases identified at the hospital from December 2002 to August 2006 met inclusion criteria and were matched to 57 controls. In univariate analysis, receipt of gadolinium-containing MRI contrast in the preceding year (odds ratio [OR], 7.99; 95% confidence interval, 2.22 to 28.8) was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure (OR, 9.83; 95% confidence interval, 2.09 to 46.2) was associated more strongly with NSF than gadoversetamide (OR, 1.82; 95% confidence interval, 0.33 to 10.2). Although not statistically significant, cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding 6 months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls. In multivariable analysis, gadolinium contrast exposure (OR, 8.97; 95% confidence interval, 1.28 to 63.0) remained significantly associated with NSF. Limitations: Retrospective design, small sample size, inability to completely evaluate erythropoietin. Conclusions: Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.
AB - Background: Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report. Study Design: Matched case-control. Setting & Participants: Dialysis patients with and without a diagnosis of NSF treated at an academic medical center. Predictor: Exposure to gadolinium-based contrast. Outcomes & Measurements: Laboratory and clinical characteristics of NSF. Results: 19 of 28 cases identified at the hospital from December 2002 to August 2006 met inclusion criteria and were matched to 57 controls. In univariate analysis, receipt of gadolinium-containing MRI contrast in the preceding year (odds ratio [OR], 7.99; 95% confidence interval, 2.22 to 28.8) was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure (OR, 9.83; 95% confidence interval, 2.09 to 46.2) was associated more strongly with NSF than gadoversetamide (OR, 1.82; 95% confidence interval, 0.33 to 10.2). Although not statistically significant, cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding 6 months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls. In multivariable analysis, gadolinium contrast exposure (OR, 8.97; 95% confidence interval, 1.28 to 63.0) remained significantly associated with NSF. Limitations: Retrospective design, small sample size, inability to completely evaluate erythropoietin. Conclusions: Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.
KW - Nephrogenic systemic fibrosis
KW - end-stage renal disease
KW - gadolinium
UR - http://www.scopus.com/inward/record.url?scp=44049099289&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2007.12.036
DO - 10.1053/j.ajkd.2007.12.036
M3 - Article
C2 - 18501784
AN - SCOPUS:44049099289
SN - 0272-6386
VL - 51
SP - 966
EP - 975
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -