D. Bradley Jackson, MDa,b; Terence MacIntyre, MSa; Vianey Duarte-Miramontes, MHAa; Joshua DeAgueroa,b,c; G. Patricia Escobar, DVMa,b,c; and Brent Wagner, MDa,b,c Correspondence: Brent Wagner (brwagner@salud.unm.edu)
aNew Mexico Veterans Administration Health Care System, Albuquerque bUniversity of New Mexico Health Sciences Center, Albuquerque cKidney Institute of New Mexico, University of New Mexico Health Science Center, Albuquerque
Author disclosures
Brent Wagner is supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health through Grant Number UL1TR001449 (CTSC/DCI Kidney Pilot Project CTSC004-12). Wagner is funded by a Veterans Health Administration Merit Award (I01 BX001958); a National Institutes of Health R01 grant (DK-102085); and partial support by the University of New Mexico (UNM) Brain and Behavioral Health Institute (BBHI 2018-1008, 2020-21-002), UNM Signature Program in Cardiovascular and Metabolic Disease and UNM School of Medicine Research Allocation Committee (C-2459-RAC, New Mexico Medical Trust). Dr. Wagner has received support from Dialysis Clinic, Inc. Wagner is an Associate Member of the University of New Mexico Health Sciences Center Autophagy, Inflammation, and Metabolism Center of Biomedical Research Excellence (AIM CoBRE) supported by NIH grant P20GM121176 and has a user agreement with the Center for Integrated Nanotechnologies (Los Alamos National Laboratory & Sandia National Laboratories, 2019AU0120, 2021BC0021).
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Ethics and consent
Verbal informed consent was obtained from the patient; patient identifiers were removed to protect the patient’s identity.
Prolonged elimination of Gd after MRI contrast administration (months to years) may be universal.10 Gd compartmentalizes into leukocytes and erythrocytes and into the cerebrospinal fluid within minutes.37,43 Patients with multisymptomatic illnesses attributed to Gd (Gd deposition disease) have perturbations in cytokine levels, many inflammatory.44,45 The results are concerning: Gd is retained intracellularly in vital organs, including brain neurons. It is inarguable that Gd is an alien, nonphysiologic element. With mounting evidence that Gd retention has clinical consequences, patients should be provided proper informed consent. Complications of renal insufficiency (ie, hyperkalemia, hyperphosphatemia, renal osteodystrophy, hyponatremia, anemia, immunosuppression, etc) follow a smooth, curvilinear slope as the true(not estimated) glomerular filtration declines; the worst iatrogenic complication from Gd—systemic fibrosis—is likely no different.
Patient Perspective
“Seems like it’s one thing after another. My family doctor said that once I had the gadolinium exposures, I have had problems ever since that I don’t recover from.” This includes chronic numbness from the rectum to the bilateral lower extremities and an indolent worsening kidney function; “I have already developed stage 3B chronic kidney disease.” Similar to many suffering with gadolinium retention, the patient was concerned about the long-term consequences. Gadolinium “is a toxic metal that is going through my body for 4 years. That has to be a problem. How come we don’t have that answer?” Clinician ignorance of Gd-induced complications and long-term retention is frustrating. “Not one of my doctors has taken gadolinium retention seriously. Where else are patients supposed to go?”
Conclusions
Health care professionals should be considering subclinical manifestations of nephrogenic systemic fibrosis or open to considering that intracellular neuronal retention of Gd may correlate with symptoms arising after MRI contrast exposures. The science concerning the mechanisms of how Gd exerts its pathologic effects is lagging behind the commercialization of enhancing Gd elimination (ie, chelation therapies) and other untested remedies. Practitioners need to acknowledge the unknown potential consequences of Gd and listen to patients who suspect chronic adverse effects.
