Gadolinium is a rare earth element used intravenously as an imaging agent to improve contrast in magnetic resonance imaging (MRI). Because it is highly toxic, gadolinium is coated with or bound to benign chemicals (chelated) to protect you until your body safely excretes all the gadolinium. If you have poor kidney function, gadolinium may not be properly removed and remain as a toxin in your system.
Removing Gadolinium From Your System
The best way to rid your body of gadolinium is not to receive it in the first place. If you have kidney or liver disease, discuss with your doctor and radiologist whether an imaging agent other than gadolinium can be used for your MRI. Also discuss if you are at risk for nephrogenic systemic fibrosis (NSF), which can occur if any gadolinium remains in your system.
Check with your doctor about whether or not you should drink extra fluids before your MRI to assist with kidney function.
Arrange to undergo dialysis directly after having your MRI if imaging with gadolinium is essential and your kidney or liver function is compromised. Your doctor will help you arrange this if it is necessary. A kidney function evaluation should be done by your doctor a few days before the MRI.
Observe all diet restrictions before dialysis, especially low sodium. Take all prescribed medicines. Do not put creams or lotions on the access site where the dialysis needle will be inserted or wear tight sleeves around the access site. A dialysis session to remove all gadolinium will most likely last several hours.
Monitor the access site for swelling, bleeding or infection after dialysis. You will also need to check for signs of gadolinium poisoning, which will occur if any trace remains in your system. Symptoms include hard or dark patches on the skin, pain and stiffness in joints, hip pain, weakness, yellow patches on the eyes and burning sensations on the skin. If these symptoms occur, additional dialysis will be needed to rid your body of the gadolinium.
Monitor for symptoms of nephrogenic systemic fibrosis (NSF). NSF is a debilitating and potentially fatal illness characterized by fibrosis of the skin, muscle and internal organs. Symptoms are similar to those of gadolinium poisoning. You are at risk of NSF if you have been exposed to gadolinium and you have severe kidney or liver disease.
The radiologist administering the MRI should not exceed the dose recommended in the product labeling and gadolinium should not be re-administered until the prior dose has been eliminated from the body.
On May 23, 2007, an FDA warning was issued for all contrast agents using gadolinium, stating patients with severe kidney insufficiency who receive gadolinium-based agents are at risk for developing NSF. Use should be avoided unless diagnostic information is essential and not available with non-contrast enhanced MRI.