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Nephrogenic systemic fibrosis is found only among gadolinium‐exposed patients with renal insufficiency: a case–control study from Denmark
Author(s) -
Elmholdt T.R.,
Pedersen M.,
Jørgensen B.,
Søndergaard K.,
Jensen J.D.,
Ramsing M.,
Olesen A.B.
Publication year - 2011
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.2011.10465.x
Subject(s) - nephrogenic systemic fibrosis , medicine , peritoneal dialysis , kidney disease , gastroenterology , cohort , stage (stratigraphy) , urology , paleontology , biology
Summary Background Nephrogenic systemic fibrosis (NSF) is a systemic fibrosing disease associated with exposure to gadolinium‐based contrast agents (GBCA) in patients with renal insufficiency. Objectives To report the prevalence of NSF in a well‐defined cohort of patients with renal insufficiency exposed to GBCA, to investigate if GBCA‐unexposed controls showed signs of NSF and to evaluate selected risk factors among NSF cases and GBCA‐exposed controls. Methods A study among GBCA‐exposed patients with renal insufficiency ( n = 565) was conducted to identify cases of NSF. The NSF cases found were age and sex matched and clinically compared with GBCA‐exposed and unexposed patients with renal insufficiency in a case–control study. Results We identified 17 NSF cases. No signs of NSF were observed among the controls. The prevalence of NSF was 4·7%, highest among patients with chronic kidney disease (CKD) stage 5 exposed to GBCA and undergoing haemodialysis or peritoneal dialysis. Three NSF cases were identified among patients with CKD stage 3 and 4. Three patients developed NSF after macrocyclic GBCA exposure. NSF cases had a tendency to have higher serum phosphate concentrations than GBCA‐exposed controls. Conclusions Our study supports the view that GBCA is a major risk factor for NSF. Importantly, we found that patients with CKD stage 3 and 4 can be at risk of NSF. NSF may also be triggered by macrocyclic GBCA. Further, we observed a trend for higher phosphate levels in NSF cases compared with controls. The important findings drawn from this case–control study indicate that NSF is not an overlooked condition among patients with renal insufficiency not exposed to GBCA.