Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure
Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure
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DOI：
10.1093/ndt/gfm584
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发表时间：
2007-11-01
影响因子：
6.1
通讯作者：
Budisavljevic, Milos N.
中科院分区：
文献类型：
--
作者：
Othersen, Jennifer B.;Maize, John C.;Budisavljevic, Milos N.
背景肾源性系统性纤维化是一种仅发生于肾衰竭患者的衰弱性疾病。肾源性系统性纤维化的病因尚不清楚，但最近的报告表明，暴露于钆增强磁共振成像可能发挥作用。在本研究中，我们评估了钆暴露与不同阶段慢性肾脏病患者肾源性系统性纤维化发展的相关性。我们分析了849例接受肾脏替代治疗超过5年的患者的钆暴露和肾源性系统性纤维化的发展。我们还调查了592例接触钆的慢性肾脏病3期和4期患者的肾源性系统性纤维化的发展情况。在2001年至2006年期间接受长期透析的849例患者中，261例接受钆（1.5）的患者中有4例发生临床明显疾病，588例未暴露于钆的患者中无一例发生临床明显疾病。单次钆暴露患者与无钆暴露患者相比，发生肾源性系统性纤维化的比值比为6.671 [95置信区间（CI）1.53753.97]。与未接受钆治疗的患者相比，多次钆暴露患者的该比值增加至44.5（95 CI 2.3622913）。在估计处于3期或4期慢性肾脏疾病的592名患者中，没有一名在接触钆后发生肾源性系统性纤维化。钆暴露与慢性肾脏替代治疗患者的肾源性系统性纤维化发生率较低相关。这种关联似乎随着重复接触钆而增加。由于肾源性系统性纤维化在临床上可能是隐匿性的，其患病率可能高于报告。尽管存在这种关联，但尚不清楚钆是否是该疾病发病机制中唯一或最重要的因素。
Background. Nephrogenic systemic fibrosis is a debilitating disease occurring exclusively in patients with renal failure. The aetiology of nephrogenic systemic fibrosis is unclear, but recent reports suggest that exposure to gadolinium for enhancement of magnetic resonance imaging may play a role. In the present study, we assessed the association of exposure to gadolinium with the development of nephrogenic systemic fibrosis in patients with various stages of chronic kidney disease.Methods. We analysed the exposure to gadolinium and development of nephrogenic systemic fibrosis in 849 patients on renal replacement therapy over 5 years. We also performed inquiry of development of the nephrogenic systemic fibrosis in 592 patients exposed to gadolinium and estimated to be in stages 3 and 4 of chronic kidney disease.Results. In 849 patients undergoing chronic dialysis from 2001 through 2006 time period, four of the 261 who had received gadolinium (1.5) and none of the 588 not exposed to gadolinium developed clinically apparent disease. The odds ratio for developing nephrogenic systemic fibrosis was 6.671 [95 confidence interval (CI) 1.53753.97] in patients with a single gadolinium exposure compared to patients without gadolinium exposure. This ratio increased to 44.5 (95 CI 2.3622913) in patients with multiple gadolinium exposures compared to patients not receiving gadolinium. None of the 592 patients estimated to be in stage 3 or 4 of chronic kidney disease developed nephrogenic systemic fibrosis after exposure to gadolinium.Conclusion. Gadolinium exposure is associated with nephrogenic systemic fibrosis in patients on chronic renal replacement therapy at a low rate. This association appears to increase with repeated exposure to gadolinium. Since nephrogenic systemic fibrosis may be clinically occult, its prevalence may be higher than reported. Despite this association, it is unclear if gadolinium is the sole or most important factor in the pathogenesis of the disease.