Gadolinium-Containing Magnetic Resonance Imaging Contrast and Nephrogenic Systemic Fibrosis: A Case-Control Study
Received 13 August 2007; accepted 10 December 2007. published online 26 March 2008.
Background
Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report.
Study Design
Matched case-control.
Setting & Participants
Dialysis patients with and without a diagnosis of NSF treated at an academic medical center.
Predictor
Exposure to gadolinium-based contrast.
Outcomes & Measurements
Laboratory and clinical characteristics of NSF.
Results
19 of 28 cases identified at the hospital from December 2002 to August 2006 met inclusion criteria and were matched to 57 controls. In univariate analysis, receipt of gadolinium-containing MRI contrast in the preceding year (odds ratio [OR], 7.99; 95% confidence interval, 2.22 to 28.8) was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure (OR, 9.83; 95% confidence interval, 2.09 to 46.2) was associated more strongly with NSF than gadoversetamide (OR, 1.82; 95% confidence interval, 0.33 to 10.2). Although not statistically significant, cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding 6 months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls. In multivariable analysis, gadolinium contrast exposure (OR, 8.97; 95% confidence interval, 1.28 to 63.0) remained significantly associated with NSF.
Limitations
Retrospective design, small sample size, inability to completely evaluate erythropoietin.
Conclusions
Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.
1Division of Healthcare Quality Promotion, National Center for Preparedness, Detection and Control of Infectious Diseases, Atlanta, GA
2Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA
3Nephrology Division, Washington University School of Medicine, St Louis, MO
4Missouri Department of Health and Senior Services, St Louis, MO
5Dermatology Division, Washington University School of Medicine, St Louis, MO
6Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA
7Division of Dermatology, Emory University, Atlanta, GA
8Nephrology Division, University of Missouri-Columbia, Columbia, MO.
Address correspondence to Alexander J. Kallen, MD, MPH, 1600 Clifton Rd NE, MS A-35, Atlanta, GA 30333.
ABSTRACT