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High-Dose Gadodiamide for Catheter Angiography and CT in Patients With Varying Degrees of Renal Insufficiency: Prevalence of Subsequent Nephrogenic Systemic Fibrosis and Decline in Renal Function

¹ Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224.
² Department of Biostatistics, Mayo Clinic Florida, Jacksonville, FL.
³ Department of Nephrology/Hypertension, Mayo Clinic Florida, Jacksonville, FL.

OBJECTIVE. The purpose of our study was to evaluate the prevalence of nephrogenic systemic fibrosis (NSF) and nephrotoxicity among patients with differing degrees of renal dysfunction who are exposed to high doses of gadodiamide.

MATERIALS AND METHODS. A search of medical records identified patients who received high-dose IV gadodiamide for catheter angiography or CT between January 2002 and December 2005. The cohort was limited to patients who had received a dose of at least 40 mL of gadodiamide during a single imaging session, who underwent at least 1 year of clinical follow-up, and who had moderate to end-stage renal disease (estimated glomerular filtration rate [GFR] < 60 mL/min/1.73 m²) established within the previous 48 hours. Any observation suggestive of NSF was recorded, as were all estimated GFR values obtained during the 2 weeks before and the 5 days after gadodiamide administration.

RESULTS. Sixty-one patients met the inclusion criteria. The median estimated GFR was 30 mL/min/1.73 m² (range, 3–57 mL/min/1.73 m²). The median gadodiamide exposure was 80 mL (range, 40–200 mL). NSF eventually developed in one of the 61 patients, yielding a prevalence of 1.6%. Among the 33 patients not undergoing dialysis with estimated GFR documented within 5 days after contrast injection, the change in estimated GFR ranged from –8.8 to 42.9 mL/min/1.73 m², with a statistically significant median improvement of 2.4 mL/min/1.73 m² (p = 0.007).

CONCLUSION. Although gadolinium exposure appears to be a necessary precondition for NSF, gadolinium-based contrast agents alone are not sufficient to cause the disorder, even in very high doses. Clinically relevant nephrotoxicity of gadolinium-based contrast agents was not found.

Keywords: gadodiamide • gadolinium-based contrast agents • nephrogenic systemic fibrosis • renal function

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