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Invited Commentary
December 9, 2019

Risk of Gadolinium-Based Contrast Agents in Chronic Kidney Disease—Is Zero Good Enough?

Author Affiliations
  • 1Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
  • 2Department of Medicine, University of Minnesota, Minneapolis
JAMA Intern Med. 2020;180(2):230-232. doi:10.1001/jamainternmed.2019.5278

In the 1990s and early 2000s, numerous patients with chronic kidney disease (CKD) were exposed to gadolinium-based contrast agents (GBCAs) for contrast-enhanced magnetic resonance imaging (MRI). At the time, the use of GBCAs was considered a safe alternative to iodinated contrast used with computed tomographic scans because the risk of contrast-induced nephropathy could be avoided. During this period, a small number of patients with CKD developed a debilitating skin condition, initially called nephrogenic fibrosing dermopathy, because the most obvious manifestations were diffuse skin thickening and fibrosis. The condition was occasionally severe enough to involve the heart, lungs, liver, and skeletal muscle and was later renamed nephrogenic systemic fibrosis (NSF). Patients with NSF experienced significant morbidity due to irreversible systemic fibrotic changes and higher mortality than patients without NSF.1

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