Application of Gadolinium-Based Contrast Agents and Prevalence of Nephrogenic Systemic Fibrosis in a Cohort of End-Stage Renal Disease Patients on Hemodialysis

Abstract

Background/Aims: Nephrogenic systemic fibrosis (NSF) is a highly debilitating disease that can occur in patients with reduced kidney function after application of gadolinium-based contrast agents (GBCA). In recent years, the incidence of the disease has significantly decreased. The aim of this study was to assess the prevalence of NSF in a cohort of dialysis patients and to investigate whether the use of GBCA has changed in this patient cohort. Methods: We studied 508 dialysis patients from 8 centers in the Ruhr area, Germany. Patients were visited during dialysis, and anamnestic data were collected by interview, from patient files and, if necessary, from radiological institutes. Patients were examined for cutaneous changes of NSF, which were defined using a scoring system based on hyperpigmentation, hardening, and tethering of skin of the extremities. Results: 4/508 patients were clinically suspected of NSF, yet only 2 had received GBCA and their diagnosis was confirmed dermatohistologically (0.4%). The other 2 had not received GBCA, and hence NSF was not suspected. Between 2006 and 2010, 49/508 patients underwent an MRI. 25/49 patients received GBCA. The relative proportion of MRIs with GBCA was highest in 2006 (9/13; 69.2%) and lowest in 2009 (6/16; 37.5%). The proportion of linear chelates (gadodiamide and gadopentetate dimeglumine) was highest in 2006 (8/9; 88.9%) and lower thereafter. Conclusion: The prevalence of NSF in our cohort of dialysis patients is very low. This may be the consequence of a progressively restricted use of GBCA in patients with impaired kidney function and a more widespread application of macrocyclic chelates.