Gadolinium Toxicity

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Gadolinium Levels in Water Supplies are Increasing: Is That Safe?

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? (more…)

Pilot study reports elevated gadolinium levels 30 days after MRIs with contrast

A new study by Alwasiyah et al. concluded that the current reference range of 0.7 μg/24hr for 24-hour urinary gadolinium is not applicable to patients for at least 30 days following exposure to a gadolinium-based contrast agent (GBCA).  In the study, the authors “calculated an estimated average of 57 days for the urinary gadolinium to creatinine ratio to reach below the current reference range following GBCA exposure and possibly much longer (i.e., 80+ days)”.  The article, “Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: a Pilot Study”, was published online December 12, 2018 in the Journal of Medical Toxicology.

This was a prospective, observational pilot study to determine urine gadolinium concentrations over a 30-day period after GBCA administration in patients with normal renal function.  The 13 subjects were between 18 and 65 years of age and were reported to have received a gadolinium-based contrast agent for the first time.  Prior to contrast administration, spot urine samples were obtained and tested for gadolinium and creatinine.  All testing was performed by Mayo Medical Laboratories in Rochester, MN.  Post-MRI 24-hour urine testing was performed on day 3, 10 and 30.  Eight subjects received gadobutrol (Gadavist®), four received gadopentetate dimeglumine (Magnevist®), and 1 received gadoxetate disodium (Eovist®) for their MRIs with contrast.  The authors reported that all 13 subjects had 24-hour gadolinium levels higher than 0.7 μg/24hr on day 3, day 10, and day 30 after contrast administration.  The authors estimated that “urinary gadolinium levels will often remain above the current reference range for >50 days”. (more…)

New MRI Safety Certification Exams cover long-term adverse effects of GBCAs

On June 24, 2015, the American Board of Magnetic Resonance Safety (ABMRS) administered exams, which will for the first time, certify Magnetic Resonance Medical Directors/Physicians (MRMD) and Magnetic Resonance Safety Officers (MRSO).  A third test, for Magnetic Resonance Safety Experts (MRSE), is expected to be ready for administration on or after the 4th quarter of 2015.

As we previously reported, the purpose of the ABMRS is to improve the safety of medical and research magnetic resonance (MR) environments.  That includes the safety of MR facilities and the certification and qualification of the professionals who oversee the physical and operational safety of the MR equipment, environment, and processes.

Dr. Emanuel Kanal, ABMRS Chairman, told us that he included in the examination content requirements that ABMRS certified MR practitioners be familiar with gadolinium based contrast agent safety issues – and that among the issues with which they want them to be familiar are long-term potential adverse effects of the administration of gadolinium-based contrast agents.   (more…)

My experience with Gadolinium urine testing

My first urine test for Gadolinium was not done until a full two years after my last dose of contrast.  Part of the delay was because I did not know about the test until almost 18 months had gone by.

I wanted my first test to be performed by Mayo Clinic Labs; however, I had difficulty making that happen.  The lab affiliated with the medical clinic where most of my doctors are located told me that they could not do any testing for heavy metals or send specimens out to another lab for the testing.  But I finally found a way around that problem.

The lab at our local hospital regularly sends specimens to Mayo Clinic in Rochester, Minnesota.  (more…)

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