Gadolinium use in patients with kidney disease: a cause for concern.

Gadolinium is widely used as a magnetic resonance imaging contrast agent and is considered to have a good overall safety profile. Recently, both renal and extra-renal toxicities have been reported following exposure to gadolinium in patients with underlying kidney disease. Gadolinium-related contrast-induced nephropathy appears to be a risk in patients with advanced kidney disease and especially those with diabetic nephropathy. Even more concerning is the strong association of gadolinium with nephrogenic systemic fibrosis (NSF), a devastating fibrosing disorder of the skin and other systemic organs. Although cause and effect have not been proven for the NSF-gadolinium link, the impaired renal elimination of gadolinium in patients with kidney disease and the instability of gadolinium-chelate binding may expose tissues to toxic free Gd(3+) and promote this fibrosing disorder. Caution should be exercised when utilizing gadolinium as a contrast agent in patients with advanced CKD or ESRD.