Systemic gadolinium toxicity in patients with renal insufficiency and renal failure: Retrospective analysis of an initial experience

T. M. Arsenault, Bernard Francis King, J. W. Marsh, J. A. Goodman, A. L. Weaver, C. P. Wood, Richard Lorne Ehman

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Abstract

Objective: To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function. Design: We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration. Material and Methods: Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study of group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available. Results: The overall incidence of adverse events in the study group was 3.6%. No event was severe or life threatening - nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control group (13.8%). Conclusion: On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.

Original languageEnglish (US)
Pages (from-to)1150-1154
Number of pages5
JournalMayo Clinic Proceedings
Volume71
Issue number12
StatePublished - 1996

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Gadolinium
Renal Insufficiency
Magnetic Resonance Imaging
Creatinine
Spine
Kidney
Mortality
Brain
Chelating Agents
Exanthema
Serum
Nausea
Population
Headache
Seizures
Research Design
Prospective Studies
Control Groups
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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Systemic gadolinium toxicity in patients with renal insufficiency and renal failure : Retrospective analysis of an initial experience. / Arsenault, T. M.; King, Bernard Francis; Marsh, J. W.; Goodman, J. A.; Weaver, A. L.; Wood, C. P.; Ehman, Richard Lorne.

In: Mayo Clinic Proceedings, Vol. 71, No. 12, 1996, p. 1150-1154.

Research output: Contribution to journalArticle

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abstract = "Objective: To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function. Design: We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration. Material and Methods: Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study of group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available. Results: The overall incidence of adverse events in the study group was 3.6{\%}. No event was severe or life threatening - nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6{\%} of the study group) in comparison with that in the control group (13.8{\%}). Conclusion: On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.",
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N2 - Objective: To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function. Design: We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration. Material and Methods: Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study of group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available. Results: The overall incidence of adverse events in the study group was 3.6%. No event was severe or life threatening - nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control group (13.8%). Conclusion: On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.

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