Gaetano Alfano1, Francesco Fontana2, Annachiara Ferrari3, Andrea Solazzo3, Rossella Perrone3, Francesco Giaroni3, Pietro Torricelli4, Gianni Cappelli5. 1. Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy; Nephrology Dialysis and Transplant Unit, University of Modena and Reggio Emilia, AOU Policlinico of Modena, Modena, Italy. Electronic address: gaetano.alfano@unimore.it. 2. Nephrology Dialysis and Transplant Unit, University of Modena and Reggio Emilia, AOU Policlinico of Modena, Modena, Italy. 3. Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy. 4. Department of Radiology, University of Modena and Reggio-Emilia, Policlinico, AOU Policlinico of Modena, Modena, Italy. 5. Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy; Nephrology Dialysis and Transplant Unit, University of Modena and Reggio Emilia, AOU Policlinico of Modena, Modena, Italy. Electronic address: gianni.cappelli@unimore.it.
Abstract
PURPOSE: Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI). METHOD: We retrospectively reviewed all the charts of kidney transplant (KT) recipients, patients on hemodialysis (HD) and peritoneal dialysis (PD) who received a uniform protocol for contrast material enhanced-MRI with gadoteric acid at our center from January 2004 to December 2017. RESULTS: Three-hundred forty-four patients (44.1% on HD, 11.3% on PD and 44.4% KT recipients) underwent 551 gadoteric acid-enhanced MRI. The median age of the patients was 58 years (IQR, 45-70 years) and 65.1% were men. Sixty-three patients (18.3%) had skin punch biopsy after integumentary assessment performed by a dermatologist. No cases of NSF were detected after a median follow-up of 4.5 years (IQR, 1.9-8.2 years). During this period of observation, 116 (33.7%) patients died and 11 (3.1%) were lost at follow-up. CONCLUSIONS: None of the patients exposed to gadoteric acid developed NSF. Our results, in line with more recent studies, suggest that the use of gadoteric acid, a macrocyclic GBCA, appears safe even in chronic kidney disease (CKD) patients receiving dialysis.
PURPOSE:Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI). METHOD: We retrospectively reviewed all the charts of kidney transplant (KT) recipients, patients on hemodialysis (HD) and peritoneal dialysis (PD) who received a uniform protocol for contrast material enhanced-MRI with gadoteric acid at our center from January 2004 to December 2017. RESULTS: Three-hundred forty-four patients (44.1% on HD, 11.3% on PD and 44.4% KT recipients) underwent 551 gadoteric acid-enhanced MRI. The median age of the patients was 58 years (IQR, 45-70 years) and 65.1% were men. Sixty-three patients (18.3%) had skin punch biopsy after integumentary assessment performed by a dermatologist. No cases of NSF were detected after a median follow-up of 4.5 years (IQR, 1.9-8.2 years). During this period of observation, 116 (33.7%) patientsdied and 11 (3.1%) were lost at follow-up. CONCLUSIONS: None of the patients exposed to gadoteric acid developed NSF. Our results, in line with more recent studies, suggest that the use of gadoteric acid, a macrocyclic GBCA, appears safe even in chronic kidney disease (CKD) patients receiving dialysis.
Authors: Joseph Lunyera; Dinushika Mohottige; Anastasia-Stefania Alexopoulos; Hilary Campbell; C Blake Cameron; Nicole Sagalla; Timothy J Amrhein; Matthew J Crowley; Jessica R Dietch; Adelaide M Gordon; Andrzej S Kosinski; Sarah Cantrell; John W Williams; Jennifer M Gierisch; Belinda Ear; Karen M Goldstein Journal: Ann Intern Med Date: 2020-06-23 Impact factor: 25.391