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Safety profile of Gadoterate meglumine on the renal function of patients with severe kidney disease

Published:September 02, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.08.021

      Highlights

      • The use of Gadolinium contrast in an MRI exam is often of critical importance for determining accurate anatomic relationships, differentiation of benign from malignant lesions, or determination of resolving vs. worsening disease.
      • Though the risk of contrast administration can never be entirely ignored, especially in patients with low eGFR, safe administration of Gadoterate meglumine can be performed even in patients with severe kidney disease.
      • No significant eGFR decrease was observed in patients who received Gadoterate meglumine compared to those who did not receive Gadoterate contrast material. There is no relationship between comorbidity, severity, and contrast selection.
      • The benefits are clear and of significant impact in numerous clinical situations where safe contrast-MRI protocols in this severe kidney disease population can be established especially in situations where contrast administration is crucial in patient diagnosis and management.

      Abstract

      Objective

      Intravenous administration of gadolinium-based contrast agents (GBCA) in patients with impaired renal function has been of concern to primary care physicians due to the potential worsening of renal dysfunction and nephrogenic systemic fibrosis (NSF). Our objective was to compare the potential change in estimated glomerular filtration rate (eGFR) in patients with known severe renal dysfunction (eGFR <30 ml/min), following Gadoterate meglumine (GM) administration with patients who do not receive contrast.

      Methods

      An IRB-approved retrospective analysis of all patients who underwent MRI examination at our institution, for any indication, between January 2016 and September 2020. Inclusion criteria: pre-MRI eGFR <30 ml/min within 24 h of MRI, follow-up eGFR between 48 and 96 h post-MRI, and absence of peritoneal or hemodialysis. The individuals who received GM (492 scans) were identified as cases, and those who did not receive contrast (1101 scans) were identified as controls for our study. Delta-eGFR response was calculated and covariate-adjusted, and propensity score analysis was performed.

      Results

      No significant eGFR decrease was observed in patients who received GM compared to those who did not receive GM in our study. Also, no relationship between comorbidity, severity and contrast selection was observed.

      Conclusion

      The use of Gadolinium contrast in MRI is often of critical importance for determining accurate anatomic relationships, differentiation of benign from malignant lesions, or determination of resolving vs. worsening disease. Though the risk of contrast administration can never be entirely ignored, especially in patients with low eGFR, our study indicates that safe administration of GM can be performed even in patients with severe kidney disease.

      Keywords

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