Hemodialysis prevents NSF in some patients

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Patients undergoing hemodialysis have a better chance of not developing nephrogenic systemic fibrosis (NSF) after receiving gadolinium-based contrast agent-enhanced MRI, according to a study published online in the September issue of Radiology.

Researchers from Weill Medical College of Cornell University and Columbia College of Physicians and Surgeons in New York City, sought to determine the incidence and associated risk factors of NSF in patients who undergo gadolinium-based contrast agent (GBCA)-enhanced MRI.

A retrospective analysis of all cases of biopsy-confirmed NSF and all patients administered a GBCA from Jan. 1, 1997 to June 30, 2007 was conducted. The incidence of NSF was calculated for patients who received a standard dose of GBCA, patients who received a high dose and subgroups of patients with renal impairment.

According to the results, of all biopsy-confirmed NSF cases, fifteen patients developed the disease after gadolinium-enhanced MRI. All of them had an estimated glomerular filtration rate (eGFR) lower than 30 mL/min, and 11 had acute renal failure or acute deterioration of chronic renal failure, the authors wrote.

The incidence of NSF after gadolinium-enhanced MR imaging without screening for renal function was zero of 74,124 patients with the standard dose of GBCA and 15 of 8,997 patients with the high dose. The NSF incidence associated with a high dose of GBCA increased to 0.4 percent in patients in a chronic hemodialysis program and to 8.8 percent in those who had an eGFR lower than 15 mL/min, but were not undergoing hemodialysis.

The NSF incidence in the patients with acute renal failure who received a high dose when their creatinine level was increasing in 11 out of 58 patients, when hemodialysis was delayed for longer than two days. More patients with NSF had pro-inflammatory events, and compared with patients without NSF, these patients had lower pH, younger age, lower eGFR, elevated serum phosphorus levels and a longer delay between GBCA injection and hemodialysis, according to the study results.

Based on their findings, the authors concluded that for patients with an eGFR lower than 15 mL/min, hemodialysis helped to prevent NSF. For patients with an eGFR lower than 30 mL/min who received a high dose of GBCA, acute renal failure, delayed hemodialysis after contrast agent injection, pro-inflammatory events and hyperphosphatemia were associated with increased risk of NSF.