SYSTEMIC GADOLINIUM TOXICITY IN PATIENTS WITH RENAL-INSUFFICIENCY ANDRENAL-FAILURE - RETROSPECTIVE ANALYSIS OF AN INITIAL EXPERIENCE

Objective: To study the possible deleterious systemic effects of gadol inium in patients with impaired renal function. Design: We retrospecti vely analyzed the routine laboratory data and clinical course of patie nts who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration. Material and Methods: Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at ou r institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly exa mined for the period from 3 days before to 30 days after the gadoliniu m-enhanced MRI examination. All data were analyzed in an attempt to de tect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimi nation times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study g roup and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available. Results: The overall incidence of adverse events in the study group was 3.6%. N o event was severe or life threatening-nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previou s studies performed in populations with normal elimination times. More over, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control gro up (13.8%). Conclusion: On the basis of this initial retrospective ana lysis, we were unable to detect any clinical deleterious effects of ad ministration of gadolinium for MRI examination in patients with impair ed renal function. Further investigation with prospective studies is n eeded to confirm these initial retrospective findings.