Risk factors for developing gadolinium-induced nephrogenic systemic fibrosis

Area of Science:

• Nephrology
• Radiology
• Pharmacology

Background:

• Nephrogenic systemic fibrosis (NSF) is a severe disorder linked to gadolinium contrast agents in patients with renal impairment.
• While gadolinium is a common factor, not all renally impaired patients develop NSF, suggesting other contributing factors.

Purpose of the Study:

• To identify medications and other potential risk factors for developing gadolinium-induced NSF, beyond renal dysfunction.
• To inform clinical practice regarding the use of gadolinium contrast agents in renally impaired patients.

Main Methods:

• Comprehensive literature search of PubMed, International Pharmaceutical Abstracts, Iowa Drug Information Service, and Google Scholar.
• Inclusion of data from FDA and contrast media manufacturers regarding NSF risk factors.
• Evaluation of articles and guidelines for concurrent medications, disease states, and other risk factors.

Main Results:

• Identified risk factors for NSF include medications causing gadolinium transmetallation or acidosis, high-dose erythropoietin, hyperphosphatemia, acidosis, recent surgery, hepatic disease, hypercoagulability, and inflammation.
• Gadolinium-based contrast agents are strongly associated with NSF in patients with severe renal impairment.

Conclusions:

• Avoid gadolinium contrast agents in patients with significant renal impairment unless benefits clearly outweigh risks.
• If gadolinium is necessary, avoid nonionic linear chelates (gadodiamide, gadoversetamide).
• Proactively screen renally impaired patients for underlying conditions and concomitant drugs that increase NSF risk.