Marckmann P et al. (2007) Case–control study of gadodiamide-related nephrogenic systemic fibrosis. Nephrol Dial Transplant [doi: 10.1093/ndt/gfm261]

Reports have indicated a link between gadolinium-containing MRI contrast agents (particularly gadodiamide) and nephrogenic systemic fibrosis (NSF; formerly known as nephrogenic fibrosing dermopathy) in people with renal failure. Not all renal failure patients exposed to these agents develop NSF, however, indicating the involvement of cofactors.

A recent case–control study included 19 patients (mean age 52 years) with histologically confirmed NSF and 19 age-matched and sex-matched controls with no signs of NSF. All participants had been exposed to gadodiamide while in stage 5 chronic kidney disease (CKD5) at the same hospital. Controls had been exposed to gadodiamide at least 12 months before the study; as NSF develops within 3 months of exposure, this period ensured that controls were unlikely to subsequently develop NSF.

The mean gadodiamide dose received by cases shortly before NSF onset was similar to the mean dose received by controls at their most-recent MRI examination (0.29 mmol/kg vs 0.28 mmol/kg). Cumulative gadodiamide exposure while in CKD5, however, was significantly higher in NSF patients than in controls (0.41 mmol/kg vs 0.31 mmol/kg; P = 0.05) and was higher in severe cases than in nonsevere cases (0.49 mmol/kg vs 0.33 mmol/kg; P = 0.02). Compared with controls, patients with NSF had significantly higher serum ionized calcium and phosphate levels (P <0.05 for both), and tended to have been receiving higher epoetin-β doses at the time of gadolinium exposure. Severe NSF mainly affected patients who had been having regular hemodialysis at the time of gadodiamide exposure, indicating that loss of residual renal function in patients with CKD5 might increase the risk of severe NSF.