Skip Navigation


NDT Advance Access originally published online on September 21, 2007
Nephrology Dialysis Transplantation 2007 22(11):3179-3185; doi:10.1093/ndt/gfm584
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow An erratum has been published
Right arrow All Versions of this Article:
22/11/3179    most recent
gfm584v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in NDT
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Othersen, J. B.
Right arrow Articles by Budisavljevic, M. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Othersen, J. B.
Right arrow Articles by Budisavljevic, M. N.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure

Jennifer B. Othersen1,2, John C. Maize, Jr.2,3, Robert F. Woolson1,2 and Milos N. Budisavljevic1,2

1Department of Biostatistics, Bioinformatics and Epidemiology, Division of Nephrology, 2Department of Dermatology, Medical University of South Carolina, Charleston and 3Maize Center for Dermatopathology, Mt Pleasant, SC, USA

Correspondence and offprint requests to: Milos N. Budisavljevic, MD, Nephrology Division, Department of Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, USA. Email: budisamn{at}musc.edu



  Abstract

Background. Nephrogenic systemic fibrosis is a debilitating disease occurring exclusively in patients with renal failure. The aetiology of nephrogenic systemic fibrosis is unclear, but recent reports suggest that exposure to gadolinium for enhancement of magnetic resonance imaging may play a role. In the present study, we assessed the association of exposure to gadolinium with the development of nephrogenic systemic fibrosis in patients with various stages of chronic kidney disease.

Methods. We analysed the exposure to gadolinium and development of nephrogenic systemic fibrosis in 849 patients on renal replacement therapy over 5 years. We also performed inquiry of development of the nephrogenic systemic fibrosis in 592 patients exposed to gadolinium and estimated to be in stages 3 and 4 of chronic kidney disease.

Results. In 849 patients undergoing chronic dialysis from 2001 through 2006 time period, four of the 261 who had received gadolinium (1.5%) and none of the 588 not exposed to gadolinium developed clinically apparent disease. The odds ratio for developing nephrogenic systemic fibrosis was 6.671 [95% confidence interval (CI) 1.537–53.97] in patients with a single gadolinium exposure compared to patients without gadolinium exposure. This ratio increased to 44.5 (95% CI 2.362–2913) in patients with multiple gadolinium exposures compared to patients not receiving gadolinium. None of the 592 patients estimated to be in stage 3 or 4 of chronic kidney disease developed nephrogenic systemic fibrosis after exposure to gadolinium.

Conclusion. Gadolinium exposure is associated with nephrogenic systemic fibrosis in patients on chronic renal replacement therapy at a low rate. This association appears to increase with repeated exposure to gadolinium. Since nephrogenic systemic fibrosis may be clinically occult, its prevalence may be higher than reported. Despite this association, it is unclear if gadolinium is the sole or most important factor in the pathogenesis of the disease.

Keywords: chronic kidney disease; end stage renal disease; gadolinium; magnetic resonance imaging; metabotropic glutamate receptors; nephrogenic systemic fibrosis

Received for publication: 28. 5.07
Accepted in revised form: 31. 7.07


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in NDT:

Nephrogenic systemic fibrosis—the need for a multidisciplinary approach
Joëlle L. Nortier and Véronique del Marmol
NDT 2007 22: 3097-3101. [Extract] [FREE Full Text]  

Case-control study of gadodiamide-related nephrogenic systemic fibrosis
Peter Marckmann, Lone Skov, Kristian Rossen, James Goya Heaf, and Henrik S. Thomsen
NDT 2007 22: 3174-3178. [Abstract] [FREE Full Text]  



This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
A. Kribben, O. Witzke, U. Hillen, J. Barkhausen, A. E. Daul, and R. Erbel
Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy.
J. Am. Coll. Cardiol., May 5, 2009; 53(18): 1621 - 1628.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
R. Agarwal, S. M. Brunelli, K. Williams, M. D. Mitchell, H. I. Feldman, and C. A. Umscheid
Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis
Nephrol. Dial. Transplant., March 1, 2009; 24(3): 856 - 863.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
M. B. Srichai, R. P. Lim, S. Wong, and V. S. Lee
Cardiovascular Applications of Phase-Contrast MRI
Am. J. Roentgenol., March 1, 2009; 192(3): 662 - 675.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
M. A. Perazella
Current Status of Gadolinium Toxicity in Patients with Kidney Disease
Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 461 - 469.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
F. G. Shellock and A. Spinazzi
MRI Safety Update 2008: Part 1, MRI Contrast Agents and Nephrogenic Systemic Fibrosis
Am. J. Roentgenol., October 1, 2008; 191(4): 1129 - 1139.
[Abstract] [Full Text] [PDF]

Home page
 CJASNHome page
J. A. Schroeder, C. Weingart, B. Coras, I. Hausser, S. Reinhold, M. Mack, V. Seybold, T. Vogt, B. Banas, F. Hofstaedter, et al.
Ultrastructural Evidence of Dermal Gadolinium Deposits in a Patient with Nephrogenic Systemic Fibrosis and End-Stage Renal Disease
Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 968 - 975.
[Abstract] [Full Text] [PDF]

Home page
 NDT PlusHome page
H. Pieringer, S. Schumacher, B. Schmekal, T. Gitter, and G. Biesenbach
Gadolinium-based contrast agents, erythropoietin and nephrogenic systemic fibrosis in patients with end-stage renal failure
NDT Plus, June 1, 2008; 1(3): 193 - 194.
[Full Text] [PDF]

Home page
 CJASNHome page
M. A. Perazella
How Should Nephrologists Approach Gadolinium-based Contrast Imaging in Patients with Kidney Disease?
Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 649 - 651.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.