New statistics report that 3-5% of end stage renal disease (ESRD) patients develop NSF. Co-existent liver failure appears to slightly increase the risk of NSF as well.
As a general guideline, in any patient with GFR< 60, try to avoid using Gd-based agents, or use alternative imaging modalities. If Gd must be given, consider using Multihance. Do not use Omniscan in this group.
ANY patient with renal disease, regardless of GFR, should not receive Omniscan. Multihance may be used as necessary, if other imaging modalities cannot be used.
Patients with GFR<30 should not receive Gd-based agents whenever possible. Consideration should be given to alternative imaging. If absolutely necessary, giving Multihance can be considered. This requires a conversation between the radiologist and referring doctor. If a Gd-based agent is used in a hemodialysis patient, every attempt should be made to perform dialysis within 2 hours. This will ordinarily require meticulous coordination between radiology, the referring physician, and nephrology. Peritoneal dialysis does not appear to be at all effective in removing Gd and therefore, administering the agent to these patients should not be performed unless absolutely necessary.
Patients with GFR 30-59 should be handled on a case-by-case basis. A discussion is required between the technologist and the radiologist. Consideration should be given to alternative imaging. Gd based agents should be avoided when possible. Omniscan should not be used. Use Multihance when appropriate in this group. There is no clear “right answer” with patients in this group. Risk of NSF is quite low.
Patients with GFR>60 and without known renal disease can be injected with any Gd solution, without restriction.
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