The safety of gadolinium in patients with stage 3 and 4 renal failure

Ergun, Ihsan; Keven, Kenan; Uruc, Irfan; Ekmekci, Yakup; Canbakan, Başol; Erden, İlhan; Karatan, Oktay

doi:10.1093/ndt/gfi304

Cited by 130 publications

(77 citation statements)

References 16 publications

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“…In contrast to the previous reports, a number of studies (27)(28)(29)(30)(31) suggested that GBC agents exhibit variable degrees of nephrotoxicity (Table 3). A retrospective study examined the effect of gadopentetate on kidney function in 260 patients, 195 of whom had underlying CKD (27).…”

Section: Presence Of Nephrotoxicity With Gbc Agentsmentioning

confidence: 68%

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Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Perazella

2009

Clinical Journal of the American Society of Nephrology

235

148

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Gadolinium-based contrast (GBC) agents have recently been the subject of intense interest for physicians across numerous specialties. These agents are widely used as contrast for magnetic resonance imaging and have been generally considered safe. Early on, phase III trials and small studies in low-risk patients suggested a benign renal profile; however, more recent studies raised the possibility of nephrotoxicity, although it is not clear whether it approaches the incidence of nephropathy associated with iodinated radiocontrast. In 2006, reports of a rare systemic fibrosing condition called nephrogenic systemic fibrosis (NSF) were recently linked to exposure of patients with advanced kidney disease to GBC agents. Analysis of the data suggests that certain GBC agents are more likely to be associated with NSF. Also, not all patients with kidney disease are at risk for developing NSF, only those with advanced acute or chronic kidney disease. Avoidance of GBC exposure is the best approach for high-risk patients. When GBC is required to obtain optimal images, use of low dosages of more stable macrocyclic agents is safer and preferred. This article reviews the current status of GBC agents as nephrotoxins and causes of NSF and provides opinions on how to use these agents in patients with underlying kidney disease.

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Section: Presence Of Nephrotoxicity With Gbc Agentsmentioning

confidence: 68%

“…A retrospective study examined 91 patients with stages 3 and 4 CKD for contrast nephrotoxicity (increase in serum creatinine of 0.5 mg/dl within 24 to 72 h) (29). The patients received one of three different GBC preparations (0.2 mmol/kg).…”

Section: Presence Of Nephrotoxicity With Gbc Agentsmentioning

confidence: 99%

Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Perazella

2009

Clinical Journal of the American Society of Nephrology

235

148

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“…Recent reports have suggested that gadolinium-based contrast agents may lead to acute renal failure in patients with advanced renal disease (22,23). We also routinely obtain images through the abdomen with steady-state free-precession gradient echo and fat-saturated T2-weighted spin echo sequences before gadolinium administration.…”

Section: Study Limitationsmentioning

confidence: 99%

Normal Values for Renal Length and Volume as Measured by Magnetic Resonance Imaging

Cheong

Muthupillai²,

Rubin³

et al. 2007

Clinical Journal of the American Society of Nephrology

222

187

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The objective of this magnetic resonance imaging (MRI) study was to (1) test the validity of the ellipsoid formula for estimating kidney volume using ex vivo and in vivo models and (2) establish a normal range of values for kidney length and volume in patients with no known history of renal disease. The volumes of five excised porcine kidneys were measured by (1) disc-summation method, (2) ellipsoid formula, and (3) water displacement method. In a retrospective, consecutive group of clinically referred patients (n ‫؍‬ 150; 300 kidneys), individual kidney volume and length were calculated by the disc-summation method and by multiplanar reformation of MRI data, respectively. For comparison, kidney volumes also were calculated using the ellipsoid formula in all patients. Renal volume that was obtained by MRI using the disc-summation method was within 5% of the volume that was determined by the water displacement method, independent of the spatial resolution of the MRI technique used. Data from both the in vivo and the ex vivo models revealed that the ellipsoid formula that commonly is used in ultrasonography underestimates renal volume by 17 to 29% compared with the disc-summation method (P < 0.05). As measured by MRI (mean ؎ SD), kidney lengths were 12.4 ؎ 0.9 cm for men and 11.6 ؎ 1.1 cm for women, and kidney volumes were 202 ؎ 36 ml for men and 154 ؎ 33 ml for women. The results from the ex vivo MRI study show that the kidney volume that was obtained using the disc-summation method is within 5% of the true kidney volume as measured by the water displacement method. The ellipsoid formula consistently and significantly underestimates the true kidney volume. The length and the volume of kidneys that are obtained by MRI in patients with no known history of intrinsic renal disease are greater than the commonly quoted reference values that are obtained by ultrasonography.

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“…This is because there are wide variations in definitions of AKI from one study to another (Table 4). AKI has been defined as an increase in sCre >0.3 mg/dL, 12 >0.5 mg/dL, 5,8,13 and >1 mg/dL. 14 Additionally, outcome data based on comorbidities before MRI examinations were not reported in many studies.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although it was thought to be safe and nonnephrotoxic at the approved doses for MRI and magnetic resonance angiography (MRA) examinations (≤0.3 mmol/kg), 4 Gd-CM has recently been reported to induce a reversible decrease of the glomerular filtration rate (GFR) in a high-risk group, especially in patients with renal impairment. [5][6][7][8][9] Additionally, patients usually have varied preexisting comorbidities [such as coronary artery disease (CAD), hypertension (HTN), diabetes, sepsis] when undergoing MRI or MRA examinations. However, additional studies have not confirmed whether these comorbid conditions are risk factors for Gd-induced nephropathy at low doses of Gd-CM.…”

Section: Introductionmentioning

confidence: 99%

Risk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment

Chien

Wang

et al. 2011

Renal Failure

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Objectives: Gadolinium-based contrast media (Gd-CM) are reported to induce acute kidney injury (AKI) in a high-risk population group at the usual dose for magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) examinations. We assessed gadolinium-induced nephropathy in patients with renal impairment who underwent MRI or MRA examinations, and evaluated the risk factors. Materials and methods: In this retrospective study, 238 patients with baseline renal impairment, who received MRI or MRA examinations with Gd-CM, were recruited. After all other AKI causes-liver decompensation, severe heart failure, all kinds of shock, and severe sepsis-and patients on dialysis were excluded, 158 patients were enrolled. AKI was defined as a decrease in glomerular filtration rate (GFR) >10% of baseline data within 3 days after administration of Gd-CM. Regression analysis was used to find independent risk factors for gadolinium-induced AKI (Gd-AKI). Results: Twenty-six of the 158 patients (16.5%) developed Gd-AKI. There were no significant differences in gender, age, or baseline GFR between those who did and who did not develop AKI. Comorbid coronary artery disease, liver cirrhosis, diabetes mellitus, and hypertension were not significantly associated with the development of Gd-AKI. However, sepsis was an independent risk factor for Gd-AKI after multivariate regression analysis (adjusted odds ratio: 4.417; 95% confidence interval: 1.671-11.676, p = 0.03). Conclusions: It is potential AKI after administration of Gd-CM under sepsis condition at the dose for MRI and MRA examinations in patients with renal impairment. It is important to identify high-risk patients and closely monitor renal function after administration of Gd-CM.

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The safety of gadolinium in patients with stage 3 and 4 renal failure

Abstract: An ARF can occur after gadolinium-based contrast agents in patients with moderate to severe chronic renal failure. Risk factors for ARF after gadolinium toxicity include diabetic nephropathy and low GFR.

Cited by 130 publications

References 16 publications

Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Normal Values for Renal Length and Volume as Measured by Magnetic Resonance Imaging

Risk of Acute Kidney Injury after Exposure to Gadolinium-Based Contrast in Patients with Renal Impairment

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