Incidence of nephrogenic systemic fibrosis at a large university hospital in Sweden

Abstract

Objective. Nephrogenic systemic fibrosis (NSF) is a rare condition that may follow administration of gadolinium-based contrast media (Gd-CM) in patients with renal insufficiency. This study was initiated to determine the incidence of NSF at Skåne University Hospital, Malmö, in Sweden. Material and methods. During the period January 2001 to December 2008 10 650 patients underwent magnetic resonance imaging (MRI) examinations. The re-expressed four-variable Modification of Diet in Renal Disease (MDRD) equation was used to calculate the estimated glomerular filtration rate (eGFR). The 272 patients with an eGFR <30 ml/min/1.73 m2 who were given Gd-CM were selected for final analysis. A diagnosis of NSF or other dermatological diagnoses in the 272 patients was searched for in the database of the Departments of Dermatology and Pathology. Results. The 272 patients, of whom 26 patients were on dialysis, had undergone 406 MRI examinations with Gd-CM. Mean follow-up time was 3.9 (±2.7 SD) years. Assuming a mean body weight of 70 kg, the overall median dose of the 406 examinations with Gd-CM was 0.14 mmol/kg body weight (0.06, 0.34; 2.5-97.5 percentiles). In this retrospective study of patients with eGFR <30 ml/min/1.73 m 2 , none developed NSF (the upper 95% confidence limit for zero cases of NSF in the 272 patients was 2.3%). Conclusion. Although it is premature to claim that Gd-CM using the regimen employed in this institution is safe to use in all patients with eGFR <30 ml/min/1.73 m 2 , the results.indicate that development of NSF is extremely uncommon.

Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast Agent

“…Characteristics of included studies are provided in Table 1 . Studies were published from May 2008 through April 2019.…”

“…Accumulating literature and newer guidelines have recognized that not all GBCAs have the same risk of NSF. The American College of Radiology (ACR) manual on contrast media, version 10.3 and the European Society of Urogenital Radiology guidelines on contrast agents, version 10.0 recognize differences in risk of NSF between GBCAs and classify GBCAs into 3 distinct (albeit slightly different) groups .…”

Nephrogenic Systemic Fibrosis in Denmark– A Nationwide Investigation

“…In a retrospective study from Sweden, no NSF patients were found when the NSF diagnosis was searched for among 272 patients with renal insufficiency exposed to GBCA [34]. However, no clinical examinations were performed either.…”

Gadolinium and nephrogenic systemic fibrosis: an update

“…This reflects a culture shift highlighted by a recent report of widely adopted policy changes among nephrologists across the USA relating to Gd contrast use in renal impairment and awareness of the risk factors and morbidity associated with NSF [62]. Since 2007, there has been a dramatic drop in the number of NSF cases reported, with multiple large studies in Sweden and the USA identifying reduced incidence or no new cases of NSF following restrictive prescribing policies [42,44,59,63]. In particular, no new pediatric cases of NSF have been reported to the Yale Registry in the period 2007-2013 (personal communication, Yale NSF Registry).…”