Dialysis does not protect patients from developing NSF. Studies have shown that the serum concentration of gadolinium is significantly decreased after hemodialysis, however, there is no information regarding residual tissue amounts2. Theoretically, the sooner the dialysis session is performed the less amount of contrast agent is deposited in the tissues. Therefore, all patients already receiving dialysis treatment should be scheduled for dialysis as soon as practical following the gadolinium-enhanced MRI and preferably within 24 hours. This should be arranged by the requesting physician in consultation with the patient’s outpatient nephrologist and dialysis unit. Routine MRI studies should be scheduled in the morning and dialysis scheduled in the afternoon following the study; radiology scheduling staff will give morning slot priority to dialysis patients. Administration of hemodialysis promptly after gadolinium may require altering the patient’s regular outpatient dialysis schedule and advance communication several days in advance with the nephrologist and dialysis unit. There is general consensus that a patient with chronic kidney disease who is not already dialysis dependent should not be started on dialysis after administration of gadolinium for precautionary purposes only, since there is no data to support the benefits of this intervention.
Key point: Dialysis should preferably be performed within 24 hours of gadolinium administration to patients already on dialysis. The institution of dialysis is not required in patients with severe renal impairment who are not already on dialysis after gadolinium administration.
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