Original InvestigationDialysisGadolinium-Containing Magnetic Resonance Imaging Contrast and Nephrogenic Systemic Fibrosis: A Case-Control Study
Section snippets
Case Definitions and Case Finding
A confirmed case was defined as clinical evidence (ie, skin thickening or hardening) and skin biopsy results consistent with NSF in a patient with renal failure in St Louis from January 1, 2000, to August 1, 2006. Suspected cases met clinical or biopsy criteria, but not both. Hospital staff searched a logbook of dermatology biopsies to identify cases. The hospital pathology database also was searched for diagnoses consistent with NSF since 2000. To identify additional cases, 8 pathology
Case Finding and Characteristics
Twenty-eight cases were identified at the hospital between December 2002 and August 2006, including 25 confirmed and 3 suspected cases.14 Expanded case finding in St Louis identified 5 additional patients with a diagnosis of NSF outside the hospital during the study period; however, additional information was unavailable for these patients. Six of the 25 confirmed cases from the hospital had insufficient health care encounters in the hospital system and therefore were excluded. Limited
Discussion
In 2006, the link between gadolinium contrast and NSF was first suggested in the literature.12 Also in that year, the Danish Medicines Agency reported 25 patients in whom NSF was diagnosed after gadolinium contrast exposure.3 Since that time, several studies have attempted to further define the role of gadolinium in NSF development and identify potential cofactors.13, 15, 16, 17, 18, 19 In this investigation, gadolinium-containing contrast was the factor most strongly associated with a
Acknowledgements
The authors acknowledge the assistance of Shawn Cowper, MD, Yale University School of Medicine and Richard Wang, DO, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention.
This report was presented in part as a poster at the 2007 National Kidney Foundation Spring Clinical Meetings, Orlando, FL, April 11, 2007. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report.14 The
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Originally published online as doi:10.1053/j.ajkd.2007.12.036 on March 27, 2008.