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Cardiac and vascular metal deposition with high mortality in nephrogenic systemic fibrosis

S Swaminathan1, W A High, J Ranville

  • 1Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. sswaminathan@uams.edu

Kidney International
|April 11, 2008
PubMed

Insights

Nephrogenic systemic fibrosis (NSF) is linked to gadolinium-based contrast agents. Metal accumulation in organs is associated with severe cardiovascular events and reduced survival in NSF patients.

Area of Science:

  • Nephrology
  • Toxicology
  • Cardiovascular Medicine

Background:

  • Nephrogenic systemic fibrosis (NSF) is a debilitating condition.
  • NSF is associated with exposure to gadolinium-based contrast media (GBCM).
  • Cardiac and vascular complications are significant causes of mortality in NSF.

Purpose of the Study:

  • To analyze clinical and laboratory records of NSF patients.
  • To identify cardiac and vascular events in NSF patients with GBCM exposure.
  • To investigate the presence of metal accumulation in tissues of NSF patients.

Main Methods:

  • Analysis of clinical and laboratory data from NSF patients.
  • Identification and documentation of cardiac and vascular events.
  • Autopsy tissue analysis (heart, blood vessels, skin) using ICP-MS and XRF for metal content.

Main Results:

  • Of 32 NSF patients, 10 died within a median of 112 days.
  • Cardiovascular events caused mortality in 9 patients, including heart failure, arrhythmias, stroke, and sudden death.
  • Autopsy revealed gadolinium, iron, and aluminum accumulation in the heart, blood vessels, and skin of deceased patients.

Conclusions:

  • Increased cardiac and vascular complications in NSF are linked to metal accumulation.
  • Metal deposition in vital organs may contribute to the high mortality rate in NSF.
  • Further research is needed to understand the mechanism of metal accumulation and its impact on NSF progression.

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