Higher death rates in kidney patients with newly recogniz...( Nephrogenic systemic fibrosis (NSF) ...),Health

Nephrogenic systemic fibrosis (NSF) is a newly identified debilitating and painful condition that affects patients with kidney failure and is characterized by a thickening and hardening of the skin. It usually affects the arms and legs but it can also affect internal organs and can progress so rapidly that patients can be immobilized and wheelchair-bound within a few weeks. Although it is not clear what causes NSF, the condition has been linked to gadolinium, a contrast agent used in MRI scans. A new study published in the October issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis) on the prevalence of NSF and its risk factors found that the disease is associated with an increased risk of dying and that gadolinium exposure is a significant risk factor for developing it.

Led by Jonathan Kay of the Massachusetts General Hospital in Boston, MA, Derrick J. Todd, Anna Kagan, and Lori B. Chibnik conducted a study on patients undergoing dialysis at six outpatient centers in the Boston area. They used a simple three-part skin examination to check for the three skin changes associated with NSF: hyperpigmentation (darkening of the skin), hardening and tethering (thickening). Patients with two out of the three findings were considered to have a positive examination for NSF and their death rates were followed for two years following the exam. The researchers chose a noninvasive skin examination in order to maximize participation and minimize the complications sometimes seen when these patients undergo surgical procedures such as biopsies. In addition, using electronic medical records, patients who had undergone scans with gadolinium-containing contrast agents were also identified and their records were examined to confirm when the exposure took place.

The results showed that of 186 patients, 25 had skin changes consistent with NSF. A total of 25 patients (2
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