Risk of nephrogenic systemic fibrosis is low in patients with chronic liver disease exposed to gadolinium-based contrast agents

Abstract

Purpose To determine the risk of nephrogenic systemic fibrosis (NSF) in a cohort of patients with chronic liver disease. Materials and Methods This retrospective, Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study was performed at a single tertiary liver center. The study cohort comprised 1167 patients with chronic liver disease followed in a liver clinic and exposed to gadolinium-based contrast agents (GBCAs) between February 2004 and October 2007. A retrospective review of medical records was performed. For each patient, data were collected on demographics, history of GBCA exposure, presence of purported risk factors for NSF, and histopathological evidence of NSF. Results Of the 1167 patients with chronic liver disease, 58% (n = 678) had cirrhosis. The patients had a total of 2421 separate GBCA exposures. Fifty-five percent (n = 646) had a single exposure, 19% (n = 218) had two exposures, and 26% (n = 303) had three or more exposures. Seventy-two percent (n = 843) of patients had renal insufficiency, 25 patients (2.1%) had hepatorenal syndrome, 80 patients (6.8%) were in the perioperative liver transplant period, and 49 patients (4.2%) had one or more additional risk factors for NSF. None of the 1167 patients developed NSF. Conclusion Chronic liver disease does not appear to be a significant risk factor for NSF.

Incidence of Nephrogenic Systemic Fibrosis Using Gadobenate Dimeglumine in 1423 Patients With Renal Insufficiency Compared With Gadodiamide

“…19,34,[38][39][40] In addition to the type of GBCA used, screening patients and avoiding GBCA administration in patients with renal insufficiency has been implemented at many institutions causing a decrease in the incidence of NSF. 11,15,[24][25][26][27][28]31,32,[39][40][41][42][43][44][45][46][47][48] Similar to other institutions, there has been a dramatic decrease in the incidence of NSF at our hospital. The precise cause for our decreased incidence of NSF cannot be determined from our study, as our institutions MR safety committee modified multiple parameters at once: physician education, screening, and the use of a different contrast agent.…”

“…In some diseases, MR is superior to other modalities, such as in imaging inflammatory and infectious processes in the brain, the diagnosis of certain liver diseases, or in the assessment of cardiac and peripheral vascular disease. 47 Furthermore, an alternative crosssectional contrast examination may not be possible, such as in the case of patients with stage 4/5 failure not yet on chronic dialysis. 28 Currently, there are reported cases of NSF with the concurrent administration of gadobenate dimeglumine and another agent in the literature; however, no cases of NSF where gadobenate dimeglumine was the sole agent administered have been definitively documented.…”

Gadobutrol in Renally Impaired Patients

“…No signs or symptoms of NSF were reported after administration of gadobenate dimeglumine or gadoteridol. Smorodinsky et al 28 retrospectively evaluated 1167 patients with chronic liver disease where 72% also had some degree of renal insufficiency. They did not report any case of NSF.…”

Gadolinium‐based contrast agents: A comprehensive risk assessment

“…Higher GBCA doses, such as those initially used for MR angiography with gadodiamide (Omniscan), are also associated with an increased risk of NSF, and the vast majority of patients diagnosed with NSF received a dose that was greater than the now standard doses for these agents . In contrast to CKD, chronic liver disease does not appear to predispose patients to NSF, as formerly thought …”

“…66,86 In contrast to CKD, chronic liver disease does not appear to predispose patients to NSF, as formerly thought. 86,88 Strategies to Minimize Risk Changes in practice patterns, such as routine screening for renal insufficiency, withholding GBCAs in patients in advanced CKD, and a widespread shift away from the highrisk GBCAs (ie, gadopentetate [Magnevist], gadodiamide [Omniscan], and gadoversetamide [OptiMARK]) have almost completely eliminated new cases of NSF. At least six prospective trials involving more than 2200 patients have been conducted to assess the risk of NSF in patients with renal impairment receiving GBCAs.…”