NSF/NFD is a very rare but very serious, and sometimes fatal, condition. It has been closely associated with the use of gadolinium-based contrast agents used in MRI's and MRA's, and so far has only occurred in people with renal insufficiency. Because there is no cure for NSF/NFD, and the condition is very resistant to treatment, there is currently a very heavy emphasis on prevention NSF Benefits Singapore.
Patients with moderate to severe renal insufficiency are at the highest risk for developing NSF/NFD. Anyone with renal insufficiency should avoid gadolinium exposure if possible, but for some people, tests using the contrast agent are necessary. In any event, patients with any level of renal insufficiency should be informed of the risks involved, and have the opportunity to decide for themselves, while taking into consideration the advice of their doctors, whether the benefits outweigh the risks.
Dose
The experts in NSF strongly recommend that when tests using contrast agents are absolutely necessary for people with renal insufficiency, the lowest effective dose should be used, especially in those with advanced kidney disease.
Dialysis
Gadolinium is primarily removed from the body by the kidneys. Therefore, people whose kidneys are not functioning properly do not eliminate the gadolinium as quickly and effectively as patients with normal functioning kidneys. Patients with normal functioning kidneys eliminate one-half of the injected gadolinium in 90 minutes while those with moderate to severe renal insufficiency, the half life of gadolinium is extended to up to 30 hours or more. This allows the gadolinium to undergo a chemical change and become distributed throughout the organs of the body The gadolinium is allowed to remain in their systems long enough to get into the skin and cause NSF/NFD.
Hemodialysis immediately after testing may eliminate some of the gadolinium. Typically, two or three, or more, sessions are needed to remove the toxin, but by doing so quickly after testing, gadolinium may not have the chance to spread throughout the body.
Hemodialysis may not be safe for everyone. Many doctors believe that patients who are not already in dialysis should not use the procedure just for gadolinium removal, because initiating dialysis can mean a permanent dependence on the procedure. Each person must be individually evaluated, and the benefits and risks of dialysis must be carefully weighed.
Different gadolinium contrast agents
All gadolinium-based contrast agents are considered to carry a possible risk of causing NSF/NFD, but some are more dangerous than others. So far, of the five gadolinium-based contrast agents approved by the FDA, only three have been linked to NSF/NFD. Most cases have occurred after the use of Omniscan, and some after using Magnevist and OptiMARK.
Some experts worry that low-risk patients will be overly cautious and go without the tests that they need. Each case has to be considered individually based on risk factors and the level of need for tests using the contrast agent.