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BMJ. 2007 June 30; 334(7608): 1335–1336.
PMCID: PMC1906672
Imaging Peripheral Disease

Gadolinium contrast may be risky in kidney disease

Peter C Thomson, research fellow in nephrology,1 Tara A Collidge, specialist registrar,1 Patrick B Mark, specialist registrar,2 and Jamie P Traynor, specialist registrar2

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.

Notes

Competing interests: None declared.

References

1. Collins R, Burch J, Aguiar-Ibanez R, Craig D, Wright K, et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ 2007;334:1257-61. (16 June.) [PMC free article] [PubMed]
2. Bradbury AW, Adam DJ. Diagnosis of peripheral arterial disease of the lower limb. BMJ 2007;334: 1229. (16 June.)
3. Grobner T, Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006;21:1104-8. [PubMed]
4. Collidge TA, Thomson PC, Mark PB, et al. Gadolinium-enhanced magnetic resonance imaging and nephrogenic systemic fibrosis—a retrospective study of a renal replacement therapy cohort. Radiology (in press).
5. Broome DR, Girguis MS, Baron PW, Cottrell AC, Kjellin I, Kirk GA. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. Am J Roentgenol 2007;188:586-92. [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group