Abstract：
OBJECTIVE: Intravenous administration of gadolinium-based contrast agents (GBCA) in patients with impaired renal function has been of concern to primary care physicians due to the potential worsening of renal dysfunction and nephrogenic systemic fibrosis (NSF). Our objective was to compare the potential change in estimated glomerular filtration rate (eGFR) in patients with known severe renal dysfunction (eGFR <30 ml/min), following Gadoterate meglumine (GM) administration with patients who do not receive contrast.
METHODS: An IRB-approved retrospective analysis of all patients who underwent MRI examination at our institution, for any indication, between January 2016 and September 2020.
METHODS: pre-MRI eGFR <30 ml/min within 24 h of MRI, follow-up eGFR between 48 and 96 h post-MRI, and absence of peritoneal or hemodialysis. The individuals who received GM (492 scans) were identified as cases, and those who did not receive contrast (1101 scans) were identified as controls for our study. Delta-eGFR response was calculated and covariate-adjusted, and propensity score analysis was performed.
RESULTS: No significant eGFR decrease was observed in patients who received GM compared to those who did not receive GM in our study. Also, no relationship between comorbidity, severity and contrast selection was observed.
CONCLUSIONS: The use of Gadolinium contrast in MRI is often of critical importance for determining accurate anatomic relationships, differentiation of benign from malignant lesions, or determination of resolving vs. worsening disease. Though the risk of contrast administration can never be entirely ignored, especially in patients with low eGFR, our study indicates that safe administration of GM can be performed even in patients with severe kidney disease.
METHODS: An IRB-approved retrospective analysis of all patients who underwent MRI examination at our institution, for any indication, between January 2016 and September 2020.
METHODS: pre-MRI eGFR <30 ml/min within 24 h of MRI, follow-up eGFR between 48 and 96 h post-MRI, and absence of peritoneal or hemodialysis. The individuals who received GM (492 scans) were identified as cases, and those who did not receive contrast (1101 scans) were identified as controls for our study. Delta-eGFR response was calculated and covariate-adjusted, and propensity score analysis was performed.
RESULTS: No significant eGFR decrease was observed in patients who received GM compared to those who did not receive GM in our study. Also, no relationship between comorbidity, severity and contrast selection was observed.
CONCLUSIONS: The use of Gadolinium contrast in MRI is often of critical importance for determining accurate anatomic relationships, differentiation of benign from malignant lesions, or determination of resolving vs. worsening disease. Though the risk of contrast administration can never be entirely ignored, especially in patients with low eGFR, our study indicates that safe administration of GM can be performed even in patients with severe kidney disease.
摘要：
目的：肾功能受损患者静脉注射钆造影剂（GBCA）一直是初级保健医生关注的问题，因为肾功能不全和肾源性系统性纤维化（NSF）的潜在恶化。我们的目的是比较已知严重肾功能不全（eGFR<30ml/min）患者的估计肾小球滤过率（eGFR）的潜在变化。在未接受造影剂的患者服用Gadoterate葡甲胺（GM）后。
方法：IRB批准的对在我们机构接受MRI检查的所有患者的回顾性分析，对于任何迹象，2016年1月至2020年9月。
方法：MRI前eGFR<30ml/min，MRI后48至96小时的随访eGFR，没有腹膜或血液透析.接受GM(492次扫描)的个体被确定为病例，未接受对比剂(1101次扫描)的患者被确定为我们研究的对照.计算Delta-eGFR反应并进行协变量调整，并进行倾向评分分析.
结果：在我们的研究中，与未接受GM的患者相比，接受GM的患者未观察到eGFR显著下降。此外，共病之间没有关系，观察严重程度和对比选择。
结论：在MRI中使用钆对比剂通常对于确定准确的解剖关系至关重要。良性和恶性病变的鉴别，或确定解决与恶化的疾病。尽管使用造影剂的风险永远不能完全忽略，尤其是eGFR低的患者，我们的研究表明,即使在患有严重肾脏疾病的患者中,也可以安全使用GM.
方法：IRB批准的对在我们机构接受MRI检查的所有患者的回顾性分析，对于任何迹象，2016年1月至2020年9月。
方法：MRI前eGFR<30ml/min，MRI后48至96小时的随访eGFR，没有腹膜或血液透析.接受GM(492次扫描)的个体被确定为病例，未接受对比剂(1101次扫描)的患者被确定为我们研究的对照.计算Delta-eGFR反应并进行协变量调整，并进行倾向评分分析.
结果：在我们的研究中，与未接受GM的患者相比，接受GM的患者未观察到eGFR显著下降。此外，共病之间没有关系，观察严重程度和对比选择。
结论：在MRI中使用钆对比剂通常对于确定准确的解剖关系至关重要。良性和恶性病变的鉴别，或确定解决与恶化的疾病。尽管使用造影剂的风险永远不能完全忽略，尤其是eGFR低的患者，我们的研究表明,即使在患有严重肾脏疾病的患者中,也可以安全使用GM.
