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Collins et al and the accompanying editorial conclude that contrast enhanced magnetic resonance angiography (MRA) is a viable alternative to conventional contrast angiography for assessing patients with peripheral arterial disease before treatment.1 2 The authors found an adverse event rate of up to 10% associated with contrast enhanced MRA, lower than other techniques and generally mild compared with conventional contrast angiography.
We draw attention to the association between the use of gadolinium based contrast agents for MRA and the development of nephrogenic systemic fibrosis,3 a newly described chronic, debilitating disease characterised by progressive fibrosis of the skin, heart, lungs and pleura with considerable morbidity and mortality. Development is predominately restricted to patients with stage V chronic kidney disease (estimated glomerular filtration rate less than 15 ml/min) and in those with acute renal failure, especially with liver failure. Most cases have been associated with the use of gadodiamide (Omniscan), some with gadopentate dimeglumine (Magnevist), and a few with gadoversetamide (Optimark)—all linear gadolinium chelates.
We found nephrogenic systemic fibrosis in 3.1% of patients receiving renal replacement therapy in Glasgow exposed to gadodiamide4—a similar finding to that of other groups5—and a dose dependent relation.
Many patients with peripheral vascular disease will have concurrent kidney disease, and the small yet clinically significant risk of developing nephrogenic systemic fibrosis should be considered when deciding whether to proceed with contrast enhanced MRA in patients with advanced kidney disease.
Competing interests: None declared.