Gadolinium-Based IV Contrast Agents (updated 8/16/18)
NSF and Gadolinium-based IV contrast agents
Assessment of Risk: Group II agents
Based on the most recent scientific and clinical evidence [30-37] the ACR Committee on Drugs and Contrast Media considers the risk of NSF among patients exposed to standard or lower than standard doses of group II GBCAs is sufficiently low or possibly nonexistent such that assessment of renal function with a questionnaire or laboratory testing is optional prior to intravenous administration.
Outpatients: Routine screening of eGFR does not need to be performed.
Inpatients: Check current Cr/eGFR (within 48 hrs).
Risk factors for renal dysfunction:
- Age > 60 years
- History of kidney disease (renal insufficiency, dialysis, transplant, single kidney, renal surgery, renal cancer)
- Diabetes
- Hypertension requiring medical therapy
MDRD Should be used to calculate GFR for adults, and the Schwartz equation should be used in children.
| eGFR | ACTION |
|
>30 mL/min
|
May administer IV gadolinium-based contrast agent |
|
<30 mL/min
|
Group II agent: to be approved by radiologist based on necessity Group I and III agents (Eovist): contraindicated |
|
Acute renal insufficency
|
Group II agent: to be approved by radiologist based on necessity Group I and III agents (Eovist): contraindicated |
|
Patient on hemodialysis
|
Group II agent: to be approved by radiologist based on necessity Group I and III agents (Eovist): contraindicated Hemodialysis should be performed within 24 hours of dose and should be arranged as such for elective and emergent MR cases. |
|
Patient on peritoneal dialysis
|
Should not receive IV contrast. If necessary, hemodialysis must be initiated (as above). |
IV Contrast and Breastfeeding
The amount of contrast material passing into the breast milk and absorbed by the infant's gut is small, and per the ACR guidelines, the patient may continue to nurse during the time period following IV contrast administration. If the mother remains concerned about any ill-effects, she may choose to pump and discard her breast milk 12 to 24 hours after contrast administration, but there is insufficient data to prove that this is necessary.