QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Peak, A. S Articles by Sheller, A. Search for Related Content PubMed PubMed Citation Articles by Peak, A. S Articles by Sheller, A.

DRUG INFORMATION ROUNDS

Risk Factors for Developing Gadolinium-Induced Nephrogenic Systemic Fibrosis

Director of Drug Information Services, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN

Amy Sheller, Pharm D Student

College of Pharmacy and Health Sciences, Butler University

Reprints: Dr. Peak, College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave., Indianapolis, IN 46208, fax 317/940-8520, apeak{at}butler.edu

OBJECTIVE: To identify medications and other potential risk factors, in addition to renal dysfunction, for developing gadolinium-induced nephrogenic systemic fibrosis (NSF).

DATA SOURCES: Information was obtained from PubMed, International Pharmaceutical Abstracts, Iowa Drug Information Service, and Google Scholar, using the unlimited search terms nephrogenic systemic fibrosis, NSF, nephrogenic fibrosing dermopathy, NFD, gadolinium, gadodiamide, gadoversetamide, gadopentetate, gadobenate, and gadoteridol. Information was also obtained from the Food and Drug Administration, as well as the manufacturers of the above-mentioned products. Data were collected during April and May 2007.

STUDY SELECTION AND DATA EXTRACTION: All identified articles and information were evaluated. Articles and other information that included data regarding concurrent medications, disease states, and other risk factors for developing gadolinium-induced NSF were included in this review, as were clinical practice guidelines.

DATA SYNTHESIS: NSF is a mysterious and severe disorder that occurs in individuals with severe renal impairment. Virtually all cases of NSF have been associated with the administration of gadolinium-containing contrast media. However, not all renally impaired patients who receive gadolinium develop NSF. Thus, additional risk factors for the development of NSF have been suggested. These risk factors include medications that could cause transmetallation of gadolinium, medications that could cause acidosis, and high doses of erythropoietin. Concomitant medical conditions, including hyperphosphatemia, acidosis, recent surgery, hepatic disease, hypercoagulability, and proinflammatory processes may also predispose patients to NSF.

CONCLUSIONS: Gadolinium-based contrast agents should be avoided in patients with significant renal impairment unless the benefits clearly outweigh the risks. If gadolinium is required, nonionic linear chelates (eg, gadodiamide, gadoversetamide) should not be used. Renally impaired individuals who require gadolinium should be screened proactively for underlying disease states and concomitant drugs that may increase their risk of developing NSF; therapy should be adjusted accordingly.

Key Words: contrast media, erythropoietin, gadolinium, nephrogenic systemic fibrosis

Published Online, August 7, 2007. www.theannals.com, DOI 10.1345/aph.1K295

This article has been cited by other articles:

				C. U. Lee, C. M. Wood, G. K. Hesley, N. Leung, M. D. Bridges, J. T. Lund, P. U. Lee, and M. R. Pittelkow Large Sample of Nephrogenic Systemic Fibrosis Cases From a Single Institution Arch Dermatol, October 1, 2009; 145(10): 1095 - 1102. [Abstract] [Full Text] [PDF]

				M. R. Prince, H. L. Zhang, J. C. Prowda, M. E. Grossman, and D. N. Silvers Nephrogenic Systemic Fibrosis and Its Impact on Abdominal Imaging RadioGraphics, October 1, 2009; 29(6): 1565 - 1574. [Abstract] [Full Text] [PDF]

				M. F. Morris, Y. Zhang, H. Zhang, J. C. Prowda, D. N. Silvers, R. A. Fawwaz, and M. R. Prince Features of Nephrogenic Systemic Fibrosis on Radiology Examinations Am. J. Roentgenol., July 1, 2009; 193(1): 61 - 69. [Abstract] [Full Text] [PDF]

				R. Agarwal, S. M. Brunelli, K. Williams, M. D. Mitchell, H. I. Feldman, and C. A. Umscheid Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis Nephrol. Dial. Transplant., March 1, 2009; 24(3): 856 - 863. [Abstract] [Full Text] [PDF]

				J. M. Provenzale Nephrogenic Systemic Fibrosis: Some Considerations on the Debate Regarding Its Cause Am. J. Roentgenol., December 1, 2008; 191(6): 1867 - 1869. [Full Text] [PDF]

				J. A. Schroeder, C. Weingart, B. Coras, I. Hausser, S. Reinhold, M. Mack, V. Seybold, T. Vogt, B. Banas, F. Hofstaedter, et al. Ultrastructural Evidence of Dermal Gadolinium Deposits in a Patient with Nephrogenic Systemic Fibrosis and End-Stage Renal Disease Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 968 - 975. [Abstract] [Full Text] [PDF]