From: Minimizing Risk of Nephrogenic systemic fibrosis in Cardiovascular Magnetic Resonance
FDA 2006 | FDA 2007 | FDA 2010 |
---|---|---|
 | Boxed Warning for GBCAs | Change in labeling for GBCAs |
Patients at risk: | Patients at risk: | Patients at risk: |
Moderate to end stage kidney disease (GFR < 60 ml/min/1.73 m²) | Acute or chronic severe renal insufficiency (GFR < 30 ml/min/1.73 m²) Acute renal insufficiency due to hepatorenal syndrome or in the perioperative phase of a liver transplant | Highest risk for patients with GFR < 30 ml/min/1.73 m² |
Repeated or high dosage GBCA enhanced procedures | ||
NO RISK: patients with normal kidney function | ||
 | Screen all patients for renal dysfunction (history and/or lab tests) | Screen all patients for renal dysfunction (history for assessment of acute kidney failure, lab tests for patients at risk for chronic renal failure) Risk factors are Diabetes, Hypertension, heart disease, smoking, obesity, high cholesterol, family history of kidney disease, age 65 or older, urinary tract infections/obstructions, systemic infections or autoimmune diseases [91] |
Measures: | Measures: | Measures: |
Carefully weigh pros and cons of GBCA enhanced imaging | avoid GBCA unless absolutely necessary | Gadodiamide, Gadoversetamid, Gadopentet Acid are contraindicated for highest risk patients |
Use alternative imaging if possible | do not exceed recommended dose | |
take the elimination half life into account and allow enough time for GBCA elimination before rescanning the patient | ||
Avoid GBCAs in patients with impaired (known/suspected) drug elimination unless absolutely necessary | ||
Consider prompt dialysis in all patients with impaired renal function | Consider prompt dialysis in patients that are already on dialysis treatment | Consider prompt dialysis in patients that are already on dialysis treatment |
 |  | Monitor patients after GBCA administration, good documentation, no repeat GBCA imaging procedures until GBCA is eliminated from the body |