[About the use of gadolinium-based contrast agents in patients with chronic kidney disease]

Gadolinium-based contrast agents (GBCA) are contrast agents used in magnetic resonance imaging (MRI). In patients with chronic kidney disease (CKD), their use has long been a source of concern due to the risk of nephrogenic systemic fibrosis. However, advances in the choice of GBCA have considerably improved their safety. Since 2017, the European Medicines Agency (EMA) has banned linear GBCA, except for a strict hepato-specific use, due to their instability and increased risk of tissue retention. Macrocyclic GBCA are much more stable and are now widely preferred. Their chemical structure enables stronger chelation of Gd3+, significantly reducing the risk of dissociation and accumulation in the body, even in patients with CKD. Recent studies have demonstrated Gd3+ accumulation in the basal ganglia after repeated administrations of linear GBCAs, even in patients with normal kidney function. To date, no clinical consequences have been demonstrated. After rigorous evaluation of the benefit-risk ratio of a GBCA injection and limitation of injected doses, MRI based on macrocyclic GBCA does not compromise the safety of patients with CKD.