Decreased Incidence of NSF in Patients on Dialysis After Changing Gadolinium Contrast-Enhanced MRI Protocols

• Authors: Diego R. Martin, Emory University; Saravanan K. Krishnamoorthy, Emory University; Bobby Kalb, Emory University; Khalil N. Salman, Emory University; Puneet Sharma, Emory University; John D. Carew, Emory University; Phillip A. Martin, University of West Georgia; Arlene Chapman, Emory University; Gaye L. Ray, Emory University; Christian Larsen, Emory University; Thomas Pearson, Emory University
• Journal Title: Journal of Magnetic Resonance Imaging
• Volume: Volume 31, Number 2
• Publisher: Wiley | 2010-02-01, Pages 440-446
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/jmri.22024
• Subjects: Health Sciences, Radiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; NSF; ESRD; dialysis; gadolinium; MRI; NEPHROGENIC SYSTEMIC FIBROSIS; GADOBENATE DIMEGLUMINE; GADOPENTETATE DIMEGLUMINE; AGENTS; GADODIAMIDE; DERMOPATHY; ANGIOGRAPHY; RELAXIVITY; ARTERIES; CHELATE

Abstract

Purpose: To retrospectively determine the incidence of nephrogenic systemic fibrosis (NSF) in patients on dialysis administered either a lower dose high-relaxivity linear gadolinium-chelate, gadobenate dimeglumine (Multi-Hance, MH), compared to a standard dose linear gadolinium chelate, gadodiamide (Omniscan, OM). Materials and Methods: This study was Health Insurance Portability and Accountability Act (HIPAA)-compliant and Institutional Review Board (IRB)-approved. As per institution standardized contrast-enhanced magnetic resonance imaging (MRI) protocols, patients on dialysis were imaged using either MH, between 2/2007 to 9/2008, or OM between 10/2003 and 1/2007. Rates of NSF were compared using 95% score-based confidence intervals (CI). The Wilcoxon rank sum test was used to test similarity/ difference between contrast doses given to each patient group. Results: Overall, 312 patients on dialysis received OM and eight (2.6%) developed NSF (95% CI: 1.30%-4.98%). In all, 784 patients on dialysis received MH at a mean cumulative dose of 0.11 mmol/kg (0.05-0.75 mmol/kg) and no cases of NSF were identified (upper 95% confidence bound of 0.45%). The mean cumulative dose of OM was 0.16 mmol/kg (0.1-0.9 mmol/kg) for all patients and 0.28 mmol/kg (0.1-0.8 mmol/kg) for the patients with NSF. The median OM dose was greater in patients who developed NSF (P = 0.03), and was greater than the median MH dose (P < 0.005).