Peter Marckmann MD, Abstract Co-Author: Nothing to Disclose

Lone Skov, Abstract Co-Author: Nothing to Disclose

Kristian Rossen MD, Abstract Co-Author: Nothing to Disclose

James Heaf MD, Abstract Co-Author: Nothing to Disclose

Henrik S. Thomsen MD, Presenter: Nothing to Disclose

NSF may be caused by Gd-containing contrast agents for MRI. Most reported cases were associated with one particular agent, gadodiamide. Yet unidentified cofactors might explain why only a minority of renal failure patients exposed to gadodiamide develop NSF.

We conducted a case-control study of 19 histologically verified cases and 19 sex-and-age-matched controls. All subjects had chronic renal failure when exposed to gadodiamide. Clinical, biochemical, and pharmacological data were retrieved from medical records.

Cases had been exposed to a mean gadodiamide dose of 0.29 mmol/kg (range 0.18-0.50) shortly before first signs of nephrogenic systemic fibrosis. Controls had been exposed to 0.28 mmol/kg (0.13-0.49). Cumulative gadodiamide exposure while in chronic kidney disease stage 5 was significantly higher among cases compared with controls (0.41 vs 0.31 mmol/kg, p = 0.05), and among severe cases (n = 9) compared with non-severe cases (0.49 vs 0.33 mmol/kg, p = 0.02). Severe cases developed primarily among patients in regular hemodialysis therapy at exposure. Cases had higher serum concentrations of ionized calcium and phosphate than controls, and tended to receive higher doses of epoietin beta than controls at time of exposure. Severe cases were treated with higher doses of epoietin beta than non-severe cases at exposure (10.8 versus 4.4 103IU/week, p = 0.02).

Increasing cumulative gadodiamide exposure, high-dose epoietin beta treatment, and higher serum concentrations of ionized calcium and phosphate increase the risk of gadodiamide-trigged NSF in renal failure patients. Severe cases seem to develop primarily among patients in regular hemodialysis therapy at exposure.

No co-factor to gadodiamide could be identified.

Marckmann, P, Skov, L, Rossen, K, Heaf, J, Thomsen, H, Case-control Study of Gadodiamide-triggered Nephrogenic Systemic Fibrosis (NSF).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5004676.html