718 0 1 mmol/kg However, in order to avoid the nephrotoxicity of iodinated HOCM, many radi ologists started using high dose GBCAS (0 3– 0 9 mmol/kg) for magnetic resonance angiography [98] Doses above[.]
718 0.1 mmol/kg However, in order to avoid the nephrotoxicity of iodinated HOCM, many radiologists started using high-dose GBCAS (0.3– 0.9 mmol/kg) for magnetic resonance angiography [98] Doses above 0.3 mmol/kg were never formally tested or approved by any regulatory agency in the USA or Europe [99] In the USA, the Food and Drug Administration (FDA) expanded the age range for use of gadopentate demegluine to patients less than years of age to parallel current regulatory guidelines in Europe The range of dosing for GBCAs has continued to decrease with dosing for several agents in pediatrics in the 0.05–0.1 mmol/kg range Of the several hundred NSF cases reported, only a few were seen in children [88, 89, 100– 102] So far, 23 children have been reported with NSF, across major data sources [103] Seventeen had documented exposure to GBCA. No characteristics that were specific to children were noted The youngest affected child was 6 years of age Even though HD can remove gadolinium, cases exist where prompt treatment was administered and yet did not prevent the development of subsequent NSF. Patients on PD have a 7.5-fold higher attack rate of NSF presumably as a result of slower clearance Current recommendations for GBCA use vary between the USA and Europe (Table 37.3) Both groups agree that GBCA risk of NSF is high when the GFR is known to be below 30 mL/ min/1.73 m2 but differs on the specifics of the recommendations The American College of Radiology recommends that a recent GFR assessment be reviewed prior to GBCA administration in high-risk patients, such as those with known prior renal disease and hypertension or following liver transplantation With the emergence of NSF, the pendulum may have swung back in favor of iodinated contrast agents for imaging when renal failure is at an advanced stage [104] Iodinated contrast nephrotoxicity is somewhat more predictable and perhaps reversible, with less threat to life Nevertheless, any contrast imaging in patients with renal failure is currently not without risk [105] V R Dharnidharka and D C Rivard Table 37.3 Current recommendations on use of GBCA US Food and Drug Administration Considers all GBCA as increasing risk for NSF (class effect) No absolute contraindications for GBCA use; advises caution when GFR below 30 mL/ min/1.73 m2 All GBCAs considered risky with liver transplantation Prompt hemodialysis recommended after an at-risk patient has received a GBCA, but prompt is not defined European medicines agency Separates out the GBCAs as below Specifies that three GBCAs (gadodiamide, gadoversetamide, and gadopentetate dimeglumine) are contraindicated in patients with GFR