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Renal Failure, Contrast Agent Linked to Systemic Fibrosis

Assessing patient risk before using gadolinium-based agent may prevent nephrogenic fibrosis

WEDNESDAY, Feb. 4 (HealthDay News) -- Awareness of risk factors involved in the suspected link between nephrogenic systemic fibrosis (NSF) and gadolinium-based contrast agent (GBCA) may help clinicians reduce the risk of this condition in patients, according to research published in the February issue of Radiology.

Javier Perez-Rodriguez, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues describe 33 patients diagnosed with NSF from 2003 to 2008. All had previously undergone MRI or an angiographic procedure using GBCA and also had advanced renal failure at the time of the exposure to GBCA.

The mean time between GBCA injection and onset of the disease was 29 days, the report indicates. Between 2003 and 2006, the overall incidence of NSF was 36.5 cases per 100,000 gadolinium-enhanced MRI procedures. After the U.S. Food and Drug Administration issued warnings in 2006 about the association between GBCA and the disease, the rate fell in 2007 and 2008 to four cases per 100,000 procedures, the researchers report.

"In January 2007, our institution implemented policies regarding the use of GBCA in patients with severe renal dysfunction, with the aim being to reduce the incidence of NSF. These policies were associated with a significant reduction in the incidence of NSF. Besides the previously reported epidemiologic considerations of NSF associations, the success of such a policy in the reduction of NSF due to GBCA exposure strengthens the belief that there is a causal relationship between GBCA and NSF," the authors write.

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