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Nephrogenic systemic fibrosis risk: is there a difference between gadolinium-based contrast agents?
Jeffrey G Penfield1, Robert F Reilly
1Division of Nephrology, Veterans Affairs North Texas Health Care System, Dallas, Texas 75216, USA. jeffrey.penfield@va.gov
Seminars in Dialysis
|January 30, 2008
Summary
Nephrogenic systemic fibrosis (NSF) risk varies among gadolinium-based contrast (GBC) agents. Agents like gadodiamide show higher NSF case numbers, potentially due to free gadolinium release in patients with kidney issues.
Area of Science:
- Nephrology
- Radiology
- Pharmacology
Background:
- Nephrogenic systemic fibrosis (NSF) is a severe condition linked to gadolinium-based contrast (GBC) agents.
- The development of NSF is proposed to result from the release of free Gd3+ in patients with impaired renal function.
Purpose of the Study:
- To evaluate the varying risks of NSF associated with different GBC agents.
- To investigate the relationship between GBC agent pharmacokinetics and the potential for free gadolinium release.
Main Methods:
- Review of reported NSF cases associated with different GBC agents.
- Analysis of GBC agent pharmacokinetics concerning free gadolinium (Gd3+) release potential.
- Consideration of market share influence on reported case numbers.
Main Results:
- Gadodiamide, gadopentetate dimeglumine, and gadoversetamide have the highest reported NSF cases.
- Gadodiamide and gadoversetamide pharmacokinetics suggest a higher likelihood of free Gd3+ release.
- Linear GBC agents are more prone to releasing free Gd3+ compared to cyclic agents like gadoteridol and gadoterate meglumine.
Conclusions:
- The risk of NSF is not uniform across all GBC agents.
- Agent structure and pharmacokinetics influence the potential for free Gd3+ release and subsequent NSF development.
- Further research on individual GBC agents is crucial for risk stratification.
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