Study Shows Risk of NSF 77 Times Higher in Dialysis Patients

Columbus, OHA new study suggests that the risk of MRI contrast side effects is as much as 77 times higher for patients undergoing dialysis. Furthermore, patients who have had a kidney transplant are 69 times more likely to develop Nephrogenic Systemic Fibrosis (NSF), a side effect of the MRI contrast agent. The combination of gadolinium and dialysis could potentially be fatal for some patients.


Published in the Archives of Dermatology in October, the study analyzed the risk of developing NSF for patients already in the at-risk group. Researchers studied patients who were exposed to NSF at the Mayo Clinic between 1999 and 2006. This included 94,917 patients exposed to MRI contrast agents, 3779 patients on hemodialysis, 1694 patients with renal transplants, and 717 patients with liver transplants, as well as 61 patients who were clinically diagnosed as having NSF.

Among the patients who developed NSF were eight out of 827 on dialysis and four out of 527 with renal transplants. None of the 327 patients with liver transplantation developed NSF.

Researchers concluded that the study "demonstrates a 77-fold higher risk of NSF among patients who undergo hemodialysis and a 69-fold higher risk in patients with renal transplantation. This increased risk is thought to be associated with poor clearance of most GBCAs."

Gadolinium-based contrast agents are used in MRIs to provide a clearer picture for diagnosis by differentiating blood vessels from nearby tissue. However, the gadolinium is expelled from the body through the kidneys. In patients with compromised kidney function, the gadolinium is not efficiently expelled from the body.

Patients with NSF experience a thickening of the skin around their joints, which makes movement increasingly difficult. Excessive scar tissue also forms around the tissue surrounding internal organs. This can eventually be fatal, as the organs are unable to function properly. Nephrogenic Systemic Fibrosis is a very painful and debilitating disorder.

Gadolinium-based contrast agents now carry a black box warning alerting patients to the risk of NSF (also known as nephrogenic fibrosing dermopathy). An FDA advisory committee will meet on December 8, 2009 to examine the warnings associated with gadolinium-based contrast agents. The committee will determine whether some agents should be contra-indicated for patients with kidney problems.