What is the prognosis of contrast-induced nephropathy (CIN) caused by gadolinium-based contrast media (CM)?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Gadolinium-based CM (used for magnetic resonance imaging [MRI]), when compared with iodine-based CM, have a similar, if not worse, adverse effect profile in patients with moderate CKD and eGFR of less than 30 mL/min. Their use has been implicated in the development of nephrogenic systemic fibrosis, a chronic debilitating condition with no cure.

A review of 3 series and 4 case reports suggested that the risk of renal insufficiency with gadolinium is similar to that of iodinated radiocontrast dye. The reported incidence varies from 4% in stage 3 CKD to 20% in stage 4 CKD, but may even be worse, as suggested by some investigators. In a study of 57 patients, acute renal failure was seen in 28% of patients in the gadolinium group, compared with 6.5% of patients in the iodinated CM group, despite prophylactic saline and N-acetylcysteine (NAC). [26]


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