Am J Kidney Dis. 2020 Aug 27:S0272-6386(20)30926-4. doi: 10.1053/j.ajkd.2020.07.012. Online ahead of print.
Gadolinium-based contrast agents (GBCA) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs which bind free gadolinium (Gd+3) more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for Gd+3 in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating Gd deposition in brain and a possible systemic syndrome attributed to GBCA. Radiologic advances have resulted in several new imaging modalities which can be used in the severe CKD population and which do not require GBCA administration. This paper is a critical review of GBCA usage in patients with severe CKD. Recommendations regarding GBCA use in this population are provided.