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Gd chelates are widely used as MRI contrast agents, and are considered to have a good overall safety profile. Early on, phase III trials and small studies in low-risk patients suggested a benign renal profile; however, more recent studies raised the possibility of nephrotoxicity, although it is not clear whether it approaches the incidence of AKI associated with iodine-containing contrast media. Gd-related AKI appears to be a risk in patients with advanced kidney disease, especially those with diabetic nephropathy.419,420 Perazella et al.420 have summarized studies showing Gd-induced nephrotoxic AKI compared to CI-AKI.421-425 Studies in patients with underlying kidney disease demonstrate the importance of renal clearance in determining the pharmacokinetic profile of Gd chelates.426 More details on the pharmacokinetics of Gd chelates and their dialyzability are provided in Appendix E.
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