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Increased Risk Of Death
Following Painful Condition Affecting Kidney Failure Patients
01
Oct 2007
As
edited by Joint-Pain-Forum.com
A
painful and debilitating condition that affects patients with kidney
failure may be more common than previously believed and appears to be
strongly associated with prior exposure to certain contrast agents used
in imaging studies. In addition, individuals with this syndrome --
called nephrogenic systemic fibrosis (NSF) -- appear to have a
significantly increased risk of dying. The findings from Massachusetts
General Hospital (MGH) investigators appear in the October issue of the
journal Arthritis & Rheumatism.
"Our
analysis found that hemodialysis patients who had undergone imaging
studies using a gadolinium-containing contrast agent have more than 10
times the risk of developing NSF as do patients with no prior exposure
to gadolinium," says Jonathan Kay, MD, director of the Rheumatology
Clinical Research Unit at MGH, the report's senior author. "Among those
with NSF, the risk of dying within two years was three to five times
greater than for patients without the condition from the same dialysis
centers."
The primary symptoms of NSF are rapid
and progressive thickening, hardening and darkening of the skin,
primarily on the arms and legs. Originally believed to affect only the
skin, the condition now is known to involve internal organs. NSF can be
extremely painful, causing the skin to contract to the point where
movement is difficult or impossible. The condition has been reported
only during the past 10 years and only among patients with abnormal
kidney function, primarily those with advanced kidney disease. In 2006,
an Austrian physician noted that NSF developed in several of his
dialysis patients who had undergone MR imaging studies using
gadolinium-containing contrast.
Reports of NSF in
the medical literature have discussed only small numbers of cases and
have not included comparative information from patients shown to not
have the disorder. To better assess the prevalence of NSF among
patients with advanced kidney disease and to examine a potential
association with gadolinium-containing contrast agents, the team led by
Derrick J. Todd, MD, PhD, now a rheumatology fellow at the Brigham
& Women's Hospital, enrolled hemodialysis patients treated at
six outpatient centers in the Boston area.
The
investigators devised a simple examination to check for the three skin
features of NSF -- tightening, thickening and darkening -- and also
collected demographic information. Available electronic medical records
for participants were analyzed for any history of imaging studies,
predominantly MRI examinations, using gadolinium-containing contrast.
Among
186 study participants, 25 (13 percent) were determined to have NSF
based on the presence of at least two of the three skin findings.
Examination of skin biopsy samples from five study participants
supported the examination-based diagnosis of NSF in each. Electronic
medical records were available for 90 participants; 17 of those had a
skin examination consistent with NSF, all but one with documented prior
exposure to gadolinium. The investigators were particularly surprised
to find that 48 percent of participants with skin changes of NSF died
within two years of their examination. Among participants without NSF,
the death rate was 20 percent, which would be expected among patients
with advanced kidney failure undergoing long-term hemodialysis
treatment.
"Our study demonstrates a definite and
very strong association between exposure to gadolinium-containing
contrast and the subsequent development of NSF," says Kay, an associate
clinical professor of Medicine at Harvard Medical School. "We need to
address the mechanism by which this devastating disease occurs and
develop effective treatment and preventive strategies, so that
gadolinium-containing contrast agents -- which provide important
clinical information -- can be used safely in patients with kidney
failure."
At this time, Kay notes, patients
scheduled to undergo such imaging studies should first have their
kidney function checked, and gadolinium-containing contrast should not
be used in those with significant underlying kidney disease. More
information is needed to determine the risk for those with milder forms
of kidney disease. The study was conducted by Todd and co-author Anna
Kagan, MD, PhD, while they were medical residents at MGH. Lori B.
Chibnik of Brigham and Women's Hospital was the study's biostatician.
----------------------------
Article
adapted by
www.Joint-Pain-Forum.com from original press release.
----------------------------
Massachusetts General Hospital (http://www.massgeneral.org/),
established in 1811, is the original and largest teaching hospital of
Harvard Medical School. The MGH conducts the largest hospital-based
research program in the United States, with an annual research budget
of more than $500 million and major research centers in AIDS,
cardiovascular research, cancer, computational and integrative biology,
cutaneous biology, human genetics, medical imaging, neurodegenerative
disorders, regenerative medicine, systems biology, transplantation
biology and photomedicine.
Source Sue McGreevey
Massachusetts
General Hospital
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