Study adds evidence for NSF risk from gadolinium
The receipt of gadolinium-containing MRI contrast is associated with nephrogenic systemic fibrosis (NSF) in a dose-dependent manner, and the use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure, according to a study in the June issue of the American Journal of Kidney Diseases.

In a matched case-control study, Alexander J. Kallen, MD, from the National Center for Preparedness, Detection and Control of Infectious Diseases in Atlanta, and colleagues examined dialysis patients with and without a diagnosis of NSF treated at an academic medical center.

According to the investigators, 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, the researchers found that the receipt of gadolinium-containing MRI contrast in the preceding year was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure was associated more strongly with NSF than gadoversetamide, the authors wrote.

Although not statistically significant, Kallen and colleagues found that the cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding six months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls, according to investigators.

In multivariable analysis, gadolinium contrast exposure remained significantly associated with NSF, according to the researchers.

The authors wrote that the trial’s retrospective design, small sample size and its inability to completely evaluate erythropoietin were its limitations.