Editorial: Gadolinium Use in Patients with Kidney Disease: A Cause for Concern

Gadolinium is widely used as a magnetic resonance imaging contrast agent and is considered to have a good overall safety profile. Recently, both renal and extra‐renal toxicities have been reported following exposure to gadolinium in patients with underlying kidney disease. Gadolinium‐related contrast‐induced nephropathy appears to be a risk in patients with advanced kidney disease and especially those with diabetic nephropathy. Even more concerning is the strong association of gadolinium with nephrogenic systemic fibrosis (NSF), a devastating fibrosing disorder of the skin and other systemic organs. Although cause and effect have not been proven for the NSF‐gadolinium link, the impaired renal elimination of gadolinium in patients with kidney disease and the instability of gadolinium‐chelate binding may expose tissues to toxic free Gd3+ and promote this fibrosing disorder. Caution should be exercised when utilizing gadolinium as a contrast agent in patients with advanced CKD or ESRD.

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