PMID- 18501785
OWN - NLM
STAT- MEDLINE
DCOM- 20080729
LR  - 20141120
IS  - 1523-6838 (Electronic)
IS  - 0272-6386 (Linking)
VI  - 51
IP  - 6
DP  - 2008 Jun
TI  - C-reactive protein levels and clinical symptoms following gadolinium 
      administration in hemodialysis patients.
PG  - 976-86
LID - 10.1053/j.ajkd.2008.02.299 [doi]
AB  - BACKGROUND: Until recently, gadolinium (Gd)-enhanced magnetic resonance imaging 
      (MRI) has increasingly replaced iodinated contrast agent examinations in dialysis 
      patients, although only limited data existed about the clinical safety of Gd 
      contrast agents in these patients. Specific clinical adverse events (AEs), 
      including nephrogenic systemic fibrosis, were linked to Gd exposure in dialysis 
      patients. An inflammatory reaction or transmetallation may be involved. STUDY 
      DESIGN: Secondary analysis of a 5-day observational study in a parent 
      cardiovascular study with repetitive cardiac MRI (32 patients) and patients 
      undergoing Gd-enhanced MRI for clinical indications (6 patients). Clinical 
      information and samples were obtained according to parent protocol. SETTING & 
      PARTICIPANTS: Dialysis patients at a university-based dialysis unit. PREDICTOR: 
      Gd-chelate complex. 37 of 38 patients underwent 64 MRI studies with 
      Gd-diethylenetriamine penta-acetic acid (Gd-DTPA). 25 of these patients underwent 
      additional MRI studies with gadobutrol (n = 10), 0.9% saline (n = 7), or both (n 
      = 8), and 1 patient received gadobutrol only. OUTCOMES: Clinical adverse events; 
      C-reactive protein (CRP) levels on days 1, 3, and 5 after MRI; Gd levels in blood 
      and urine after MRI. RESULTS: CRP levels increased 10-fold on day 3 after MRI in 
      87% of MRI studies with Gd-DTPA (+59.3 +/- 57.9 mg/L [P < 0.001] versus -0.9 +/- 
      3.7 mg/L with gadobutrol versus -0.9 +/- 8.5 mg/L with 0.9% saline). 77 mild to 
      moderate and 3 serious AEs were observed in 24 patients. CRP levels and adverse 
      events did not correlate with Gd blood concentrations. CRP level increase or AEs 
      were not observed after MRI with gadobutrol or 0.9% saline. LIMITATIONS: 
      Observational study without randomization, risk of bias because of multiple MRI 
      studies in a limited patient cohort. CONCLUSION: Gd-DTPA, but not gadobutrol, 
      induces an acute-phase reaction and clinical AEs in dialysis patients. Additional 
      investigations have to analyze the underlying pathomechanism.
FAU - Schieren, Gisela
AU  - Schieren G
AD  - Department of Nephrology, University Hospital, Heinrich-Heine-University 
      Dusseldorf, Germany. gisela.schieren@med.uni-duesseldorf.de
FAU - Tokmak, Faruk
AU  - Tokmak F
FAU - Lefringhausen, Lutz
AU  - Lefringhausen L
FAU - van Bracht, Mark
AU  - van Bracht M
FAU - Perings, Christian
AU  - Perings C
FAU - Willers, Reinhardt
AU  - Willers R
FAU - Gunsel, Andreas
AU  - Gunsel A
FAU - Kemper, Fritz
AU  - Kemper F
FAU - Wiesmuller, Gerhard Andreas
AU  - Wiesmuller GA
FAU - Rump, Lars Christian
AU  - Rump LC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Contrast Media)
RN  - 0 (Organometallic Compounds)
RN  - 1BJ477IO2L (gadobutrol)
RN  - 9007-41-4 (C-Reactive Protein)
RN  - K2I13DR72L (Gadolinium DTPA)
SB  - IM
CIN - Am J Kidney Dis. 2008 Nov;52(5):1021; author reply 1021-2. PMID: 18971016
MH  - C-Reactive Protein/*analysis
MH  - Contrast Media/*adverse effects
MH  - Female
MH  - Gadolinium DTPA/*adverse effects
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Organometallic Compounds/*adverse effects
MH  - Prospective Studies
MH  - *Renal Dialysis
EDAT- 2008/05/27 09:00
MHDA- 2008/07/30 09:00
CRDT- 2008/05/27 09:00
PHST- 2007/07/10 00:00 [received]
PHST- 2008/02/25 00:00 [accepted]
PHST- 2008/05/27 09:00 [pubmed]
PHST- 2008/07/30 09:00 [medline]
PHST- 2008/05/27 09:00 [entrez]
AID - S0272-6386(08)00529-5 [pii]
AID - 10.1053/j.ajkd.2008.02.299 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 2008 Jun;51(6):976-86. doi: 10.1053/j.ajkd.2008.02.299.