Perspective:

The discovery of an association between gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF) has minimized use of GBCA-enhanced magnetic resonance imaging in dialysis patients and patients with severe renal failure at risk of NSF. Recent surveys suggest that many high magnetic resonance volume institutions have not had any NSF cases in the last 3-4 years. Reductions in risk for NSF may be attained with each of the following strategies:

1. Avoiding high doses of GBCA (>0.1 mmol/kg);

2. Avoiding nonionic linear chelates in patients undergoing dialysis and patients with glomerular filtration rate <30 ml/min, especially in the setting of proinflammatory conditions;

3. Dialyzing quickly after GBCA administration for patients already on dialysis; and

4. Avoiding GBCA in acute renal failure, especially while serum creatinine level is rising.