C-Reactive Protein Levels and Clinical Symptoms Following Gadolinium Administration in Hemodialysis Patients
Received 10 July 2007; accepted 25 February 2008.
Refers to article:
Gadolinium-Containing Magnetic Resonance Imaging Contrast and Nephrogenic Systemic Fibrosis: A Case-Control Study
, 26 March 2008
Alexander J. Kallen, Michael A. Jhung, Steven Cheng, Theresa Hess, George Turabelidze, Liana Abramova, Matthew Arduino, Jeannette Guarner, Brian Pollack, Georges Saab, Priti R. Patel
American Journal of Kidney Diseases
June 2008 (Vol. 51, Issue 6, Pages 966-975) Abstract |
Full Text |
Full-Text PDF (241 KB)
Background
Until recently, gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) has increasingly replaced iodinated contrast agent examinations in dialysis patients, although only limited data existed about the clinical safety of Gd contrast agents in these patients. Specific clinical adverse events (AEs), including nephrogenic systemic fibrosis, were linked to Gd exposure in dialysis patients. An inflammatory reaction or transmetallation may be involved.
Study Design
Secondary analysis of a 5-day observational study in a parent cardiovascular study with repetitive cardiac MRI (32 patients) and patients undergoing Gd-enhanced MRI for clinical indications (6 patients). Clinical information and samples were obtained according to parent protocol.
Setting & Participants
Dialysis patients at a university-based dialysis unit.
Predictor
Gd-chelate complex. 37 of 38 patients underwent 64 MRI studies with Gd-diethylenetriamine penta-acetic acid (Gd-DTPA). 25 of these patients underwent additional MRI studies with gadobutrol (n = 10), 0.9% saline (n = 7), or both (n = 8), and 1 patient received gadobutrol only.
Outcomes
Clinical adverse events; C-reactive protein (CRP) levels on days 1, 3, and 5 after MRI; Gd levels in blood and urine after MRI.
Results
CRP levels increased 10-fold on day 3 after MRI in 87% of MRI studies with Gd-DTPA (+59.3 ± 57.9 mg/L [P < 0.001] versus −0.9 ± 3.7 mg/L with gadobutrol versus −0.9 ± 8.5 mg/L with 0.9% saline). 77 mild to moderate and 3 serious AEs were observed in 24 patients. CRP levels and adverse events did not correlate with Gd blood concentrations. CRP level increase or AEs were not observed after MRI with gadobutrol or 0.9% saline.
Limitations
Observational study without randomization, risk of bias because of multiple MRI studies in a limited patient cohort.
Conclusion
Gd-DTPA, but not gadobutrol, induces an acute-phase reaction and clinical AEs in dialysis patients. Additional investigations have to analyze the underlying pathomechanism.
Address correspondence to Gisela Schieren, MD, Department of Nephrology, University Hospital, Heinrich-Heine-University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
ABSTRACT