Section of Nephrology, Yale School of Medicine, New Haven, CT 06520-8029, USA.
Adv Chronic Kidney Dis. 2011 May;18(3):188-98. doi: 10.1053/j.ackd.2011.03.001.
The strong association between nephrogenic systemic fibrosis (NSF) and exposure to gadolinium-based contrast agents (GBCAs) has greatly affected the care of patients with kidney disease. NSF has been reported in patients with ESRD, CKD, and acute kidney injury (AKI). The majority of cases have occurred in patients with ESRD, but about 20% have been reported in patients with AKI or CKD stages 4 and 5. There is also a risk difference among GBCAs, with the Food and Drug Administration contraindicating 3 linear agents in patients at risk. Given the significant morbidity and mortality of NSF, it is imperative to identify individuals at risk. Although there are no data to support a role for hemodialysis (HD) in reducing the risk for NSF after administration of GBCAs, immediate HD is still recommended within 2 hours. Patients maintained on peritoneal dialysis seem to be at high risk and immediate HD is also recommended. However, this is not the current recommendation for CKD stages 4 and 5, especially with suspected lower risk of noncontraindicated agents. Individualized assessment is important and especially in those patients close to dialysis initiation. Instituting policies is important to address the imaging needs of patients with CKD and AKI while ensuring a balance between benefits and risks.
肾源性系统性纤维化（NSF）与含钆对比剂（GBCA）暴露之间的强关联极大地影响了肾病患者的治疗。NSF 已在终末期肾病（ESRD）、慢性肾脏病（CKD）和急性肾损伤（AKI）患者中报道。大多数病例发生在 ESRD 患者中，但约 20%的病例发生在 AKI 或 CKD 4 期和 5 期患者中。GBCA 之间也存在风险差异，美国食品药品监督管理局（FDA）在有风险的患者中禁止使用 3 种线性药物。鉴于 NSF 的发病率和死亡率很高，必须识别出有风险的个体。尽管没有数据支持 GBCA 给药后血液透析（HD）可降低 NSF 的风险，但仍建议在给药后 2 小时内立即进行 HD。接受腹膜透析的患者似乎风险很高，也建议立即进行 HD。然而，这不是目前对 CKD 4 期和 5 期的推荐，尤其是对于可疑的非禁忌药物风险较低的患者。个体化评估很重要，尤其是在那些接近开始透析的患者中。制定政策对于解决 CKD 和 AKI 患者的影像学需求很重要，同时要在获益和风险之间取得平衡。
