State of Practice: ASNR Statement on Gadolinium-Based Contrast Agent Use in Patients with Chronic Kidney Disease

Beginning in 2006, neuroradiologists became increasingly aware of the risk of nephrogenic system fibrosis (NSF) when patients with chronic kidney disease (CKD) received gadolinium-based contrast agents (GBCAs) in conjunction with MRI scans. Radiology practices began withholding GBCAs from MRI patients with substantial CKD and instated a variety of safety measures to ensure that these individuals did not inadvertently receive GBCAs. As a result, the worldwide incidence of NSF was dramatically reduced. Since that time, a wealth of research on NSF and its etiology has found few unconfounded cases associated with those GBCAs categorized as group II agents by the American College of Radiology.

In 2023 and 2024, members of the American Society of Neuroradiology (ASNR) Standards and Guidelines Committee reviewed new research evidence on GBCA safety and its relevance to current MRI contrast administration guidelines for patients with CKD. This focused on systematic reviews and meta-analyses conducted during the past 5 years. Upon consideration of this literature, recommendations for the administration of GBCAs to patients with CKD were formulated.

For neuroimaging applications, the ASNR recommends that group II GBCAs no longer be withheld in patients with CKD when these agents are medically indicated for diagnosis. Moreover, if group II GBCAs are exclusively used in an MRI practice, other safety measures, such as checking renal function or querying patients about CKD, can be discontinued.