Risks of gadolinium
What is gadolinium and what risks are associated with it?
Gadolinium is a lanthanide metal with paramagnetic properties, making it a suitable contrast agent. Initially, it was assumed to be a safe alternative to iodinated contrast; however, subsequently, it was shown to cause nephrogenic systemic fibrosis (NSF) in patients on dialysis or with severe impairment of kidney function.
NSF is a severe fibrosing disorder of the skin and other organs that can be debilitating and fatal. The majority of cases of NSF occur in patients with end-stage kidney disease who were receiving renal replacement therapy. No cases have been reported with stage 1 to 3 CKD, and only a few cases with CKD 4. If gadolinium must be administered in patients with advanced CKD, experts recommend:
• Using a macrocyclic ionic chelate-based gadolinium rather than linear nonionic type
• Administering the lowest dosage possible
• Avoiding repeated exposures
• Consider hemodialysis after gadolinium administration.
• Due to the risk of NSF in patients at high-risk for CIN, gadolinium contrast media cannot be recommended for the reduction of CIN risk.