Nephrogenic systemic fibrosis (NSF) is a devastating complication of severe renal failure. Recent reports suggest that exposure to gadolinium-containing contrast agents (GCCA) is associated with the occurrence of NSF. The population of patients with ESRD in and around Bridgeport, CT, was studied during an 18-mo period. The incidence of NSF was 4.3 cases per 1000 patient-years. Each radiologic study using gadolinium presented a 2.4% risk for NSF. The association between gadolinium exposure and NSF was highly significant (P < 0.001). It is concluded that GCCA exposure is a major risk factor for NSF in the ESRD population. Because of the significant morbidity and mortality with NSF, it is believed that gadolinium exposure should be avoided in patients with ESRD. In the event that exposure cannot be avoided, careful consideration of the potential consequences, including a thorough discussion of the risks and benefits of GCCA, is advised.Clin J Am Soc Nephrol 2: 264 -267, 2007264 -267, . doi: 10.2215 N ephrogenic systemic fibrosis (NSF) is a systemic disorder that is characterized by thickening and tightening of the skin and subcutaneous tissues (1). First observed in 1997, NSF was originally known as nephrogenic fibrosing dermopathy because of its classic presentation of symmetric, brawny, or erythematous indurated cutaneous plaques that develop in the setting of renal insufficiency (2,3). Recognition that this syndrome can include fibrosis of skeletal muscle, lung, liver, testes, or myocardium with possible fatal outcomes led to the adoption of the more recent nomenclature: Nephrogenic systemic fibrosis (4,5).The cause of NSF remains speculative. Hypercoagulation syndromes, anti-phospholipid antibodies, deep vein thrombosis, metabolic acidosis, erythropoietin administration, and surgical or vascular interventions all have been implicated as possible contributing factors (6 -9). Several recent reports described the development of NSF after gadolinium exposure (9 -11). To follow up on these reports, we reviewed the use of gadolinium in our long-term dialysis population during an 18-mo period and analyzed its relationship to the development of NSF. Materials and MethodsWe retrospectively analyzed data from a population of patients who had ESRD and were living in the nine urban and suburban communities that surround Bridgeport, CT. The study population consisted of patients who had ESRD and were treated at one of three hemodialysis facilities or one peritoneal dialysis facility on July 1, 2006. These four programs were the only dialysis facilities in this geographic area, thus providing a population based study.Within this population, three cases of NSF were diagnosed in the 18-mo period that ended on July 1, 2006. Patients were identified on clinical grounds with confirmatory skin biopsies. The relationship between gadolinium exposure and NSF was documented, and details of the cases were recorded. The remaining patients who had ESRD and did not develop NSF served as the control group.We manually reviewed data from al...