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AKI has been known to be a significant risk factor for NSF with high-risk GBCAs. 2008 Mar;158(3):607-10. doi: 10.1111/j.1365-2133.2007.08369.x. The limitations relate more to the source studies and gleaned information rather than the methodology. Direct editorial input from an Associate Editor and a Deputy Editor. This serves to highlight any and all organs that have vascular flow. Chelates are either linear or macrocyclic, ionic or nonionic (Table 11-5). Hence, a history of any previous gadolinium-based contrast agent exposure, risk factors for, or known, kidney disease, and possible pregnancy, should be sought. IV contrast: Gadolinium is an IV contrast agent used for mri. 2009 Oct;32(10):377-82. The world scientific community also remains in general agreement that gadolinium contrast should probably never be given to patients with severe renal impairment (eGFR < 30 mL/min/1.73m²) unless there is an overarching clinical benefit identified. Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Epub 2018 Dec 26. It is now thought that less than 1 in 100 people with severe kidney function impairment who have these lower-risk types of gadolinium contrast will develop NSF. As long as kidney function is … Gonzalez-Rodriguez R, Campbell E, Naumov A. PLoS One. 9 September 2010 ,FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction Contrast dyes are often used during MRI to enhance the images obtained, and these dyes contain an element called gadolinium. Initially reported most commonly in end stage renal disease (ESRD) patients receiving dialysis, it is also described in patients with severe acute kidney injury (AKI) and advanced chronic kidney disease (stages 4 and 5) not requiring dialysis. These are important differentiating points given the much higher likelihood of AKI among inpatients. Gadolinium is widely employed as a contrast agent for magnetic resonance imaging (MRI) and has generally been considered to be safe. Repeat dosing in at-risk patients within a short time is best avoided unless absolutely necessary, and generally not before 7 days per European Society of Urogenital Radiology recommendations. The chelate reduces the chances of toxicity that could result from exposure to gadolinium. In addition, reports of a previously rare condition entitled nephrogenic systemic fibrosis (NSF) have recently emerged in patients with advanced kidney disease and have been linked to exposure to gadolinium-contrast. AJR Am J Roentgenol 1998;171(5):1277–1278. EMA's final opinion confirms restrictions on use of linear gadolinium agents in body scans. What Are the Implications for Nephrologists? As with iodinated radiocontrast, concern for contrast-induced nephropathy existed with gadolinium- contrast as it possessed many similar qualities (hyperosmolar, renal excretion via glomerular filtration). By continuing you agree to the, https://doi.org/10.1053/j.ajkd.2020.03.011, Use of Gadolinium-Based Contrast Agents in Kidney Disease Patients: Time for Change, https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf, https://www.ema.europa.eu/en/medicines/human/referrals/gadolinium-containing-contrast-agents-0, https://www.ema.europa.eu/en/medicines/human/referrals/gadolinium-containing-contrast-agents, Group I: associated with the greatest number of NSF cases (termed high or highest risk by EMA/ESUR), Gadopentetate dimeglumine (Magnevist; Bayer HealthCare Pharmaceuticals), Gadoversetamide (OptiMARK; Mallinckdrodt/Guerbet), Group II: associated with few, if any, unconfounded cases of NSF (termed low or lowest risk by EMA/ESUR except for MultiHance), Gadobenate dimeglumine (MultiHance; Bracco Diagnostics), Gadoterate meglumine (Dotarem; Guerbet/Clariscan; GE Healthcare), Gadoteridol (ProHance; Bracco Diagnostics), Gadobutrol (Gadavist/Gadovist; Bayer HealthCare Pharmaceuticals), Group III: Data remain limited regarding NSF risk, but few if any unconfounded cases of NSF have been reported (termed medium or intermediate risk by EMA/ESUR), Gadoxetate disodium (Eovist/Primovist; Bayer HealthCare Pharmaceuticals). 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