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    Nephrogenic systemic fibrosis after gadopentetate dimeglumine exposure: case series of 36 patients

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    Authors
    Abujudeh, Hani H.
    Kaewlai, Rathachai
    Kagan, Anna
    Chibnik, Lori B.
    Nazarian, Rosalynn M.
    High, Whitney A.
    Kay, Jonathan
    UMass Chan Affiliations
    Department of Medicine, Division of Rheumatology
    Document Type
    Journal Article
    Publication Date
    2009-10-01
    Keywords
    Adult
    Aged
    Aged, 80 and over
    Biopsy
    Contrast Media
    Dose-Response Relationship, Drug
    Female
    Gadolinium DTPA
    Humans
    *Magnetic Resonance Imaging
    Male
    Middle Aged
    Nephrogenic Fibrosing Dermopathy
    Proportional Hazards Models
    Retrospective Studies
    Risk Factors
    Severity of Illness Index
    Musculoskeletal Diseases
    Radiology
    Rheumatology
    Skin and Connective Tissue Diseases
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    Link to Full Text
    http://dx.doi.org/10.1148/radiol.2531082160
    Abstract
    PURPOSE: To retrospectively assess the association between gadopentetate dimeglumine exposure at magnetic resonance imaging and the development of nephrogenic systemic fibrosis (NSF). MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval. Informed consent was waived. A search of medical and pathologic records was performed to identify patients with NSF that was diagnosed between January 1998 and December 2007. Patients with known exposure to gadolinium-based contrast agents other than gadopentetate dimeglumine were excluded. Medical records were then reviewed for gadopentetate dimeglumine exposure, renal status, concomitant diseases, timing of NSF symptom onset, date of NSF diagnosis, and clinical outcome. Skin gadolinium deposition was assessed for those patients with adequate available tissue. Spearman rank correlations were estimated to assess the relationship between the dose of gadopentetate dimeglumine and the time to onset of NSF. RESULTS: Thirty-six patients (mean age, 62.6 years; range, 30-83 years) had been exposed to gadopentetate dimeglumine prior to NSF onset. All had stage 5 chronic kidney disease and all but one were undergoing dialysis at the time of exposure. NSF developed within 3 months after the last gadopentetate dimeglumine exposure (range, 1-59 months) in 21 (66%) of 32 patients. The patients had been exposed to median cumulative gadopentetate dimeglumine volumes of 35, 40, 85, and 117.5 mL over the 3, 12, and 24 months and up to 11 years preceding the onset of NSF, respectively. Patients who received higher cumulative and total gadopentetate dimeglumine doses had a higher risk of developing NSF than did those who received lower doses (odds ratio = 1.2). Twenty (56%) of 36 patients died, with a median interval of 18 months between NSF symptom onset and death. CONCLUSION: NSF develops in patients with renal impairment after exposure to gadopentetate dimeglumine in a dose- and time-dependent manner. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082160/-/DC1.
    Source
    Radiology. 2009 Oct;253(1):81-9. doi: 10.1148/radiol.2531082160. Epub 2009 Aug 25. Link to article on publisher's site
    DOI
    10.1148/radiol.2531082160
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48766
    PubMed ID
    19709997
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1148/radiol.2531082160
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