Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review

Area of Science:

• Radiology
• Nephrology
• Pharmacology

Background:

• Gadolinium-based contrast agents (GBCAs) enhance MRI diagnostics.
• GBCA use in severe chronic kidney disease (CKD) was linked to nephrogenic systemic fibrosis (NSF).
• Current GBCA policies and agent selection have significantly reduced NSF incidence.

Purpose of the Study:

• To critically review GBCA use in patients with severe CKD.
• To address ongoing physician concerns regarding GBCA safety in severe CKD.
• To provide recommendations for GBCA administration in this patient population.

Main Methods:

• Review of contemporary studies on GBCA use in severe CKD.
• Analysis of data on gadolinium deposition and potential systemic syndromes.
• Evaluation of alternative imaging modalities for severe CKD patients.

Main Results:

• Modern GBCAs with high binding affinity show an absence of NSF in severe CKD.
• Restrictive policies and agent selection have led to the virtual elimination of NSF.
• Despite evidence, physician concerns regarding GBCA use in severe CKD remain.

Conclusions:

• Contemporary GBCAs are associated with an absence of NSF in severe CKD.
• Physician concerns persist due to gadolinium deposition and potential systemic effects.
• Alternative imaging modalities offer GBCA-free options for severe CKD patients.