Table 5 Recommendations for specific patient groups by the American College of Radiology, 2010
From: Minimizing Risk of Nephrogenic systemic fibrosis in Cardiovascular Magnetic Resonance
Chronic Kidney Disease Stage 1 or 2 | No special measures |
(eGFR 60 to 119 ml/min/1.73 m2) | |
Chronic Kidney Disease Stage 3a | Lowest possible dose of GBCA for diagnostic studies. If possible, avoid high risk GBCAs |
(eGFR 45- 59 ml/min/1.73 m2) | |
Chronic Kidney Disease Stage 3b | GBCA use should be safe if dosage is restricted to 0.1 mmol/kg or less. Apply same safety measures as in the following group |
(eGFR 30- 44 ml/min/1.73 m2) | |
Chronic Kidney Disease Stage 4 or 5 not on chronic dialysis | If feasible, avoid all contrast media. If usage is not avoidable, use lowest possible dose, avoid high risk GBCAs, avoid readministration of GBCAs for a week |
(eGFR <30 ml/min/1.73 m2) | |
End-stage renal disease with chronic dialysis | Consider change of imaging modality. Avoid high risk GBCAs, use lowest possible dose. Schedule the imaging study as close as possible before the next routine hemodialysis session. |
(eGFR 45- 59 ml/min/1.73 m2) | |
Acute kidney injury | If possible avoid any GBCA administration, regardless of eGFR. If GBCA use is necessary, avoid high risk GBCAs, use lowest possible dose. |
Pregnancy | If possible, avoid use of GBCA, unless such an imaging study is absolutely necessary. |
Pediatrics | Use similar safety measures as in adults. Neonates can have an eGFR of less than 30 ml/min/1.73 m³ but is not considered an absolute contraindication. |