Removal of gadolinium by dialysis: review of different strategies and techniques.

Nephrogenic systemic fibrosis (NSF) has been related to the administration of gadolinium-based contrast agents for magnetic resonance imaging studies in patients with kidney disease. After reviewing the pathophysiology of NSF, we discuss the possible factors contributing to the toxicity of gadolinium in susceptible patients, including the excessive amounts of intravenous iron and erythropoietin as well as the inflammatory states commonly seen in patients treated with hemodialysis. Since free gadolinium is the most accepted risk factor for NSF, we provide some suggestions to improve clearance of both free and chelated gadolinium using different dialysis strategies and techniques. J. Magn. Reson. Imaging 2009;30:1347-1349. (c) 2009 Wiley-Liss, Inc.