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Limiting Gadolinium Use May Avert Renal Systemic Fibrosis

Last Updated: May 20, 2011.

Following the adoption of restrictive guidelines for gadolinium-based contrast agent administration, no new nephrogenic systemic fibrosis cases have been identified in contrast-enhanced magnetic resonance examinations, even in patients with a low estimated glomerular filtration rate, according to a study published online May 17 in Radiology.

FRIDAY, May 20 (HealthDay News) -- Following the adoption of restrictive guidelines for gadolinium-based contrast agent (GBCA) administration, no new nephrogenic systemic fibrosis (NSF) cases have been identified in contrast-enhanced magnetic resonance (MR) examinations, even in patients with a low estimated glomerular filtration rate (eGFR), according to a study published online May 17 in Radiology.

Yingbing Wang, M.D., from Massachusetts General Hospital in Boston, and colleagues compared the incidence of NSF before and after the adoption of restrictive GBCA administration guidelines in 2007. The guidelines limited the maximum GBCA dose to 20 mL in patients with low eGFR (60 mL/min/m²) and prohibited its use in patients with very low eGFR (below 30 mL/min/m²) or those undergoing chronic dialysis. Contrast material-enhanced MR imaging examinations and biopsy-confirmed cases of NSF were compared for the period between 2002 and 2007 (pre-guideline adoption and transitional period) and between 2008 and 2010 (post-guideline adoption).

The investigators identified 52,954 contrast-enhanced MR examinations during the post-guideline adoption period with 88 percent of them performed in adult patients with presumed normal renal function and an eGFR of 60 mL/min/m² or higher, and 12 percent performed in patients with an eGFR of 30 to 59 mL/min/m². Contrast-enhanced MR imaging for emergent indications were performed in 36 patients with an eGFR lower than 30 mL/min/m². No new cases of NSF from GBCA exposure were recorded between 2008 and 2010.

"After restrictive guidelines regarding GBCA administration were instituted, no new cases of NSF were identified among 52,954 contrast-enhanced MR examinations, including those performed in patients with an eGFR lower than 60 mL/min/m²," the authors write.

Two authors disclosed financial relationships with Bracco Diagnostics, which is involved in trials of a contrast agent containing gadolinium.

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