Nephrogenic systemic fibrosis: A frivolous entity

Table 1 American College of Radiology manual classification of gadolinium-based agents relative to nephrogenic systemic fibrosis

Group I: Agents associated with the greatest number of NSF cases:

Gadodiamide (Omniscan® – GE Healthcare)

Gadopentetate dimeglumine (Magnevist® – Bayer HealthCare Pharmaceuticals)

Gadoversetamide (OptiMARK® – Guerbet)

Group II: Agents associated with few, if any, cases of NSF:

Gadobenate dimeglumine (MultiHance® – Bracco Diagnostics)

Gadobutrol (Gadavist® – Bayer HealthCare Pharmaceuticals; Gadovist in many countries)

Gadoteric acid (Dotarem® – Guerbet, Clariscan – GE Healthcare)

Gadoteridol (ProHance® – Bracco Diagnostics)

Group III: Agents for which data remains limited regarding NSF risk, but for which few, if any cases of NSF have been reported:

Gadoxetate disodium (Eovist – Bayer HealthCare Pharmaceuticals; Primovist in many countries)

NSF: Nephrogenic systemic fibrosis.

Table 2 Patients at high risk of nephrogenic systemic fibrosis

Risk factors for NSF
Patients on dialysis (hemodialysis or peritoneal dialysis)
Advanced or end-stage CKD (CKD 4 or 5, eGFR < 30 mL/min/1.73 m2) without dialysis
Acute kidney injury
Proinflammatory state in a patient with impaired kidney function
Higher doses and multiple administrations of GBCAs, within a short period of time

NSF: Nephrogenic systemic fibrosis; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate.