Gadolinium-enhanced MR Imaging and Nephrogenic Systemic Fibrosis: Retrospective Study of a Renal Replacement Therapy Cohort

Purpose: To retrospectively compare the frequency of administration and cumulative dose of gadolinium-based contrast agent in dialysis-dependent patients who did and those who did not develop nephrogenic systemic fibrosis.

Materials and Methods: The ethics committees granted exempt status for this study and also waived the need for informed consent. A retrospective analysis was performed of all adult patients undergoing dialysis in the west of Scotland between January 1, 2000, and July 1, 2006. Diagnoses of nephrogenic systemic fibrosis, episodes of gadolinium-enhanced magnetic resonance (MR) imaging, and cumulative doses of gadolinium-based contrast agent were recorded. Outcomes were analyzed by means of parametric and nonparametric testing.

Results: Fourteen of 1826 patients had a diagnosis of nephrogenic systemic fibrosis. Mortality was similar for affected and nonaffected patients. Thirteen (93%) of 14 patients with nephrogenic systemic fibrosis had undergone gadolinium-enhanced MR imaging compared with 408 (22.5%) of 1812 nonaffected patients (P < .001). Patients with nephrogenic systemic fibrosis received a higher median cumulative dose of gadodiamide (0.39 vs 0.23 mmol per kilogram of body weight, P = .008) and underwent more gadolinium-enhanced MR imaging than their nonaffected gadolinium-exposed counterparts.

Conclusion: The data support a positive association between gadolinium-based contrast agent administration and development of nephrogenic systemic fibrosis in the established renal failure population; in addition, there is a positive association between cumulative dose of gadodiamide used and dosing events.

© RSNA, 2007

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  • 1 Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE. Scleromyxoedema-like cutaneous diseases in renaldialysis patients. Lancet 2000; 356(9234): 1000–1001. Crossref, MedlineGoogle Scholar
  • 2 Cowper SE. The International Center for Nephrogenic Fibrosing Dermopathy Research (ICNFDR) Web site. Accessed October 1, 2006. Google Scholar
  • 3 Mendoza FA, Artlett CM, Sandorfi N, Latinis K, Piera-Velazquez S, Jimenez SA. Description of 12 cases of nephrogenic fibrosing dermopathy and review of the literature. Semin Arthritis Rheum 2006; 35(4): 238–249. Crossref, MedlineGoogle Scholar
  • 4 Swartz RD, Crofford LJ, Phan SH, Ike RW, Su LD. Nephrogenic fibrosing dermopathy: a novel cutaneous fibrosing disorder in patients with renal failure. Am J Med 2003; 114(7): 563–572. Crossref, MedlineGoogle Scholar
  • 5 Mackay-Wiggan JM, Cohen DJ, Hardy MA, Knobler EH, Grossman ME. Nephrogenic fibrosing dermopathy (scleromyxedema-like illness of renal disease). J Am Acad Dermatol 2003; 48(1): 55–60. Crossref, MedlineGoogle Scholar
  • 6 Streams BN, Liu V, Liégeois N, Moschella SM. Clinical and pathologic features of nephrogenic fibrosing dermopathy: a report of two cases. J Am Acad Dermatol 2003; 48(1): 42–47. Crossref, MedlineGoogle Scholar
  • 7 Daram SR, Cortese CM, Bastani B. Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis: report of a new case with literature review. Am J Kidney Dis 2005; 46(4): 754–759. Crossref, MedlineGoogle Scholar
  • 8 Ting WW, Stone MS, Madison KC, Kurtz K. Nephrogenic fibrosing dermopathy with systemic involvement. Arch Dermatol 2003; 139(7): 903–906. Crossref, MedlineGoogle Scholar
  • 9 Jiménez SA, Artlett CM, Sandorfi N, et al. Dialysis-associated systemic fibrosis (nephrogenic fibrosing dermopathy): study of inflammatory cells and transforming growth factor beta1 expression in affected skin. Arthritis Rheum 2004; 50(8): 2660–2666. Crossref, MedlineGoogle Scholar
  • 10 Gilliet M, Cozzio A, Burg G, Nestle FO. Successful treatment of three cases of nephrogenic fibrosing dermopathy with extracorporeal photopheresis. Br J Dermatol 2005; 152(3): 531–536. Crossref, MedlineGoogle Scholar
  • 11 Läuchli S, Zortea-Caflisch C, Nestle FO, Burg G, Kempf W. Nephrogenic fibrosing dermopathy treated with extracorporeal photopheresis. Dermatology 2004; 208(3): 278–280. Crossref, MedlineGoogle Scholar
  • 12 Schmook T, Budde K, Ulrich C, Neumayer HH, Fritsche L, Stockfleth E. Successful treatment of nephrogenic fibrosing dermopathy in a kidney transplant recipient with photodynamic therapy. Nephrol Dial Transplant 2005; 20(1): 220–222. Crossref, MedlineGoogle Scholar
  • 13 Kafi R, Fisher GJ, Quan T, et al. UV-A1 phototherapy improves nephrogenic fibrosing dermopathy. Arch Dermatol 2004; 140(11): 1322–1324. Crossref, MedlineGoogle Scholar
  • 14 Cowper SE, Bucala R. Nephrogenic fibrosing dermopathy: suspect identified, motive unclear. Am J Dermatopathol 2003; 25(4): 358. Crossref, MedlineGoogle Scholar
  • 15 Cowper SE. Nephrogenic fibrosing dermopathy: the first 6 years. Curr Opin Rheumatol 2003; 15(6): 785–790. Crossref, MedlineGoogle Scholar
  • 16 Scottish Renal Association. Scottish renal registry report 2001. Edinburgh, Scotland: Information & Statistics Division, 2003; 45. Google Scholar
  • 17 Hubbard V, Davenport A, Jarmulowicz M, Rustin M. Scleromyxoedema-like changes in four renal dialysis patients. Br J Dermatol 2003; 148(3): 563–568. Crossref, MedlineGoogle Scholar
  • 18 Maloo M, Abt P, Kashyap R, et al. Nephrogenic systemic fibrosis among liver transplant recipients: a single institution experience and topic update. Am J Transplant 2006; 6(9): 2212–2217. Crossref, MedlineGoogle Scholar
  • 19 Kucher C, Steere J, Elenitsas R, Siegel DL, Xu X. Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis with diaphragmatic involvement in a patient with respiratory failure. J Am Acad Dermatol 2006; 54(2 suppl): S31–S34. Crossref, MedlineGoogle Scholar
  • 20 Mark PB, Johnston N, Groenning BA, et al. Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int 2006; 69(10): 1839–1845. Crossref, MedlineGoogle Scholar
  • 21 Broome DR, Girguis MS, Baron PW, Cottrell AC, Kjellin I, Kirk GA. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR Am J Roentgenol 2007; 188(2): 586–592. Crossref, MedlineGoogle Scholar
  • 22 Grobner T. Gadolinium: a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006; 21(4): 1104–1108.[Published correction appears in Nephrol Dial Transplant 2006;21(6):1745.] Crossref, MedlineGoogle Scholar
  • 23 Marckmann P, Skov L, Rossen K, et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 2006; 17(9): 2359–2362. Crossref, MedlineGoogle Scholar
  • 24 Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE. Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 2007; 242(3): 647–649. LinkGoogle Scholar
  • 25 DeHoratius DM, Cowper SE. Nephrogenic systemic fibrosis: an emerging threat among renal patients. Semin Dial 2006; 19(3): 191–194. Crossref, MedlineGoogle Scholar
  • 26 Sadowski EA, Bennett LK, Chan MR, et al. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 2007; 243: 148–157. LinkGoogle Scholar
  • 27 Boyd AS, Zic JA, Abraham JL. Gadolinium deposition in nephrogenic fibrosing dermopathy. J Am Acad Dermatol 2007; 56(1): 27–30. Crossref, MedlineGoogle Scholar
  • 28 High WA, Ayers RA, Chandler J, Zito G, Cowper SE. Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007; 56(1): 21–26. Crossref, MedlineGoogle Scholar
  • 29 VanWagoner M, O'Toole M, Worah D, Leese PT, Quay SC. A phase I clinical trial with gadodiamide injection, a nonionic magnetic resonance imaging enhancement agent. Invest Radiol 1991; 26(11): 980–986. Crossref, MedlineGoogle Scholar
  • 30 Joffe P, Thomsen HS, Meusel M. Pharmacokinetics of gadodiamide injection in patients with severe renal insufficiency and patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis. Acad Radiol 1998; 5(7): 491–502. Crossref, MedlineGoogle Scholar
  • 31 Khurana A, Runge VM, Narayanan M, Greene JF, Nickel AE. Nephrogenic systemic fibrosis: a review of 6 cases temporally related to gadodiamide injection (Omniscan). Invest Radiol 2007; 42(2): 139–145. Crossref, MedlineGoogle Scholar
  • 32 Thomson HS. Contrast media: safety issues and ESUR guidelines. Berlin, Germany: Springer-Verlag, 2005; 173. Google Scholar
  • 33 Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol 2006; 16(12): 2619–2621. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2007