The increasing levels of gadolinium found in lakes, bays, rivers, and water supplies around the world correlate with the increased administration of gadolinium-based contrast agents (GBCAs) for MRIs. The gadolinium (Gd) from those GBCAs that gets into our water is called anthropogenic gadolinium since it comes from human activity. Some studies refer to it as a Gd anomaly and note that it is difficult to remove by the usual sewage treatment technology. This is not a new problem, but it is one that requires further investigation to confirm that gadolinium is not absorbed by the GI tract since it could be ingested via drinking water. It seems that might be of even greater concern for infants, children, and pregnant women. Besides being in our drinking water, a 2019 study by Schmidt et al. found anthropogenic gadolinium, in similar concentrations, in tap-water and in a related water-based popular fountain soft drink from two fast food restaurants in six major German cities. That study provided the first evidence that anthropogenic gadolinium in contrast agents enters the human food chain.

A recent study by Inoue et al. reported a significant increase in the Gd anomaly in the rivers in Tokyo, compared to data obtained 22 years ago, depending on the location of the wastewater treatment plants. The amount of Gd had increased by as much as 6.6 times since the assessment 22 years ago. That coincides with the significant increase in the number of MRI scanners in Japan and scans performed with a GBCA. The study notes that common wastewater treatment plants cannot remove gadolinium, so it is released back into the environment. That fact is well-documented in the literature.

A 2020 study by Brünjes and Hofmann found that “contrary to previous assumptions that GBCAs are stable throughout the water cycle, they can degrade.” The authors noted that there is specific concern that “UV end-of-pipe treatment” may enhance the risks posed by GBCAs in drinking water. They noted that increasing GBCA concentrations could become a concern in settings where drinking water is produced from raw water resources with a high proportion of recycled wastewater. They said that during drinking water production, improved water purification would require using expensive reverse osmosis as it is the only efficient way to fully remove GBCAs.  The authors suggested a novel way to reduce the input of gadolinium into the aquatic environment and its potential health risk, and it is to have patients collect urine in leakproof collection bags that include super absorbent polymers for at least 24 hours following administration of GBCAs. Urine would need to be collected not only in hospitals, but also in patients’ homes. It appears that a pilot study by Niederste-Hollenberg et al. was done in Germany in 2018 that had a high level of acceptance by patients.

Is collecting urine after contrast-enhanced MRIs enough to solve the potential problems that might be caused by anthropogenic gadolinium in our drinking water?

My Thoughts –

Collecting urine from patients for 24 hours after their contrast-enhanced MRIs will not solve the problem of anthropogenic gadolinium since patients are excreting significant amounts of gadolinium for much longer than 24 hours after their MRIs with a GBCA; some are excreting it for many months and years after contrast administration.

Based on the gadolinium urine testing data we have in our database, GBCAs are not eliminated as quickly as indicated in GBCA package labeling – not even close to it.  Our 2018 paper, Gadolinium Clearance Times for 135 Contrast MRI Cases, reports test results by agent administered, and results for all agents were above the Mayo Clinic reference range of 0.7 mcg/24 Hours for much longer than expected.  A 2018 pilot study by Alwasiyah et al. confirms what we have been saying about prolonged gadolinium excretion in patients with normal renal function. Alwasiyah estimated that it would take more than 50 days to get below the reference range of 0.7 mcg/24 Hours. (Note that Mayo Clinic’s reference range is now up to 1.0 mcg/24 Hours).

Is gadolinium in our water supplies safe?

Anthropogenic gadolinium has been suggested to explain some of the gadolinium detected in urine specimens of patients with normal renal function, as though it would be a benign source of the toxic metal.  Although I have read studies that indicate gadolinium is “poorly absorbed by the gastrointestinal tract”, I have not found published evidence of that.  What I have found is a 1961 study by Haley et al. with rats that found that the chronic oral ingestion of gadolinium chloride and samarium chloride caused liver damage, skin ulceration, and eventually cardiopulmonary collapse. Lanthanum is another lanthanide metal like gadolinium that is also thought to be poorly absorbed by the GI tract, but that does not seem to be case. Lanthanum carbonate is a phosphate binder that is taken orally by end-stage renal disease (ESRD) patients. Although thought to be poorly absorbed by the GI tract, studies have found lanthanum in bone, liver, gastric mucosa, and elsewhere in the body of some patients, which indicates that at least some of it is being absorbed.  The question then becomes, is it harmful?  While we need to learn more, two rat studies (Feng et al., 2006 & He et al., 2008) found that long-term oral administration of lanthanum may be involved in neurological adverse effects. Lanthanum and gadolinium are both rare earth elements (REEs), so we might expect similar effects from ingested gadolinium.

We could continue to assume that someone would have to drink very large amounts of tap water containing anthropogenic gadolinium before the level of gadolinium in their body might cause them any harm; however, it is never wise to assume anything, especially when someone’s health could be adversely affected.

I believe that everyone should be concerned about the increasing amount of gadolinium that is in our water supplies in the U.S. and around the world.  We also need to consider the cumulative effects of ingesting gadolinium, even low levels of it repeatedly. If gadolinium is absorbed by the GI tract, many more people may be at risk of being affected by the long-term effects of gadolinium toxicity.

Sharon Williams
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References:
Thomsen, H. S. (2016). Are the increasing amounts of gadolinium in surface and tap water dangerous? Acta Radiologica, 58(3), 259–263. https://doi.org/10.1177/0284185116666419

Hatje V, Bruland KW, F. A. (n.d.). Increases in anthropogenic gadolinium anomalies and rare earth element concentrations in San Francisco Bay over a twenty-year record. Retrieved January 24, 2016, from http://pubs.acs.org/doi/pdf/10.1021/acs.est.5b04322

Schmidt, K., Bau, M., Merschel, G., & Tepe, N. (2019). Anthropogenic gadolinium in tap water and in tap water-based beverages from fast-food franchises in six major cities in Germany. Science of The Total Environment, 687, 1401–1408. https://doi.org/10.1016/j.scitotenv.2019.07.075

Inoue, K., Fukushi, M., Furukawa, A., Sahoo, S. K., Veerasamy, N., Ichimura, K., … Nakazawa, S. (2020). Impact on gadolinium anomaly in river waters in Tokyo related to the increased number of MRI devices in use. Marine Pollution Bulletin, 154, 111148. https://doi.org/10.1016/j.marpolbul.2020.111148

Brünjes, R., & Hofmann, T. (2020). Anthropogenic gadolinium in freshwater and drinking water systems. Water Research, 115966. https://doi.org/10.1016/j.watres.2020.115966

Niederste-Hollenberg, J., Eckartz, K., Peters, A., Hillenbrand, T., Maier, U., Beer, M., & Reszt, A. (2018). Reducing the emission of X-Ray contrast agents to the environment. Gaia 27, 147–155. Retrieved from https://doi.org/10.14512/gaia.27.1.10

Grimm, H., & Williams, S. (2018). Gadolinium Clearance Times for 135 Contrast MRI Cases Including Urine Test Results by Agent Administered for 63 Unconfounded Cases. Retrieved from https://gadoliniumtoxicity.com/gadolinium-clearance-times-for-135-contrast-mri-cases-final-v1-1/

Alwasiyah, D., Murphy, C., Jannetto, P., Hogg, M., & Beuhler, M. C. (2018). Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: A Pilot Study. Journal of Medical Toxicology. https://doi.org/10.1007/s13181-018-0693-1

Mayo Clinic, 2020. Test ID: GDU. Gadolinium, 24 Hour, Urine. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/89301

HALEY, T. J., RAYMOND, K., KOMESU, N., & UPHAM, H. C. (1961). Toxicological and pharmacological effects of gadolinium and samarium chlorides. British Journal of Pharmacology and Chemotherapy, 17, 526–532. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1482085&tool=pmcentrez&rendertype=abstract

Slatopolsky, E., Liapis, H., & Finch, J. (2005). Progressive accumulation of lanthanum in the liver of normal and uremic rats. Kidney International, 68(6), 2809–2813. Retrieved from http://dx.doi.org/10.1111/j.1523-1755.2005.00753.x

Lacour, B., Lucas, A., Auchère, D., Ruellan, N., de Serre Patey, N. M., & Drüeke, T. B. (2005). Chronic renal failure is associated with increased tissue deposition of lanthanum after 28-day oral administration. Kidney International, 67(3), 1062–1069. https://doi.org/10.1111/j.1523-1755.2005.00171.x

Spasovoski, G., & et al. (2006). Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up. Retrieved September 2, 2013, from http://ndt.oxfordjournals.org/content/early/2006/04/04/ndt.gfl146.full.pdf

Davis, R. L., & Abraham, J. L. (2009). Lanthanum deposition in a dialysis patient – Exceptional Case. Nephrology Dialysis Transplant, 1–3. Retrieved from http://ndt.oxfordjournals.org/content/early/2009/07/22/ndt.gfp364.full.pdf

Makino, M., Kawaguchi, K., Shimojo, H., Nakamura, H., Nagasawa, M., & Kodama, R. (2015). Extensive lanthanum deposition in the gastric mucosa: The first histopathological report. Pathology International, 65(1), 33–37. https://doi.org/10.1111/pin.12227

Feng, L., Xiao, H., He, X., Li, Z., Li, F., Liu, N., … Chai, Z. (2006). Neurotoxicological consequence of long-term exposure to lanthanum. Toxicology Letters, 165(2), 112–120. Retrieved from https://doi.org/10.1016/j.toxlet.2006.02.003

He, X., Zhang, Z., Zhang, H., Zhao, Y., & Chai, Z. (2008). Neurotoxicological Evaluation of Long-Term Lanthanum Chloride Exposure in Rats. Toxicological Sciences, 103(2), 354–361. https://doi.org/10.1093/toxsci/kfn046