Group II GBCM Can Be Used Safely for Imaging in Stage 4/5 CKD Patients: COMMENTARY

In 2006, the first reported association between an antecedent exposure to gadolinium‐based contrast media (GBCM) and the development of nephrogenic systemic fibrosis (NSF) ignited a debate on the safety of these agents in patients with kidney disease, with ensuing severe and appropriate-use restrictions put in place. In this issue of Kidney360 , this debate is revived 15 years later, but with the tide reversing as their use is being reconsidered in these same patients. This debilitating, and often fatal, disease has fortunately receded into memory for many nephrologists. Its practical disappearance can be credited to both the implementation of protocols limiting GBCM use in patients with impaired kidney function or those on maintenance dialysis and the contraindication in those with CKD stages 4–5D or AKI (by the Food and Drug Administration [FDA] and the European Medicines Agency [EMA]) of the three most offending group I or high‐risk GBCM, as per the American College of Radiology classification (Table 1) (1). Restrictions on the use of the other available GBCM in patients with kidney disease remain in place today at many centers around the world. In fact, the FDA black-box warning for group II, or low‐risk, agents still carry a cautionary note on their use in patients with kidney disease. Recent data have emerged highlighting the safety of these agents in both patients with CKD stages 4–5 and those with ESKD, thus prompting a re‐evaluation of practice and policies. The recent calls to revisit the restrictions in place take into consideration their unintended consequences, such as the acquisition of suboptimal diagnostic studies, a concern no longer overshadowed by the risk for NSF. View this table: Table 1. Classification of gadolinium‐based media according to their risk for nephrogenic systemic fibrosis by three organizations Although …