• Ann. Intern. Med. · Jul 2020

    Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review.

    • Joseph Lunyera, Dinushika Mohottige, Anastasia-Stefania Alexopoulos, Hilary Campbell, C Blake Cameron, Nicole Sagalla, Timothy J Amrhein, Matthew J Crowley, Jessica R Dietch, Adelaide M Gordon, Andrzej S Kosinski, Sarah Cantrell, John W Williams, Jennifer M Gierisch, Belinda Ear, and Karen M Goldstein.
    • Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.).
    • Ann. Intern. Med. 2020 Jul 21; 173 (2): 110-119.

    BackgroundThe risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear.PurposeTo synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function.Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020.Study SelectionRandomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure.Data ExtractionData were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools.Data SynthesisOf 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease.LimitationsStudy heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment.ConclusionAlthough NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations.Primary Funding SourceU.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…