Gadolinium Toxicity

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The viewpoints presented here include Gadolinium Toxicity news and thoughts about various aspects of living with the effects of Gadolinium Toxicity.  They may just be one person’s idea or an experience that happened to them.  These viewpoints are important to share, because someone looking at them from a different viewpoint may be able to tie some things together in a way that we did not see.

Gadolinium Toxicity – Let’s not make the same mistake again

An Editorial by Hubbs Grimm
August 2018

(A pdf of this Editorial is available for download)

I want to talk about the unfortunate results of the early studies of gadolinium toxicity that defined NSF and the parallels I see today in the effort to define Gadolinium Deposition Disease (GDD).  I will also propose an alternative view of how to describe gadolinium toxicity in a way that reflects what we currently know and do not know that will recognize all patients who have been affected by retained gadolinium.

Before I begin, I want to be clear that I believe all those who have contributed in the past and those who are contributing today are doing so with the best of intentions and working from the basis of their experience and perspective.  But that does not mean that the result or proposals are necessarily best for meeting the needs of the people who are suffering from the toxic effects of gadolinium.

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Gadolinium Toxicity: If not NSF, then what is it?

Editorial by Sharon Williams
August 2018

(A pdf of this Editorial is available for download)

What difference does a name make?  Evidently, when you are naming a disease it can make a huge difference.  The name can limit the scope of medical research, and when it comes to gadolinium, it has the potential to exclude other patient populations who have been exposed to the same toxic metal.

In 1997, when a group of patients on dialysis developed what appeared to be a new skin disorder, it was called Nephrogenic Fibrosing Dermopathy (NFD).  When researchers later learned that the problem went well beyond the patients’ skin and caused a systemic disease process, the name was changed to Nephrogenic Systemic Fibrosis (NSF).  The word “nephrogenic” in the name caused doctors and researchers to focus on people with severe renal disease.  At the beginning, that made sense since the problem only had been seen in patients with end-stage renal disease (ESRD).  Later we learned more about the cause.

In 2006, nine years after NSF/NFD was first diagnosed, the connection was made between NSF and gadolinium-based contrast agents (GBCAs) administered for MRIs.  Even though impaired kidney function did not cause NSF, the focus remained on the “N” or nephrogenic part of NSF.  Patients with normal kidney function were being overlooked; however, they were not unaffected by retained gadolinium from GBCAs.

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Gadolinium Toxicity – Status and Direction – August 2018

The two of us, Sharon Williams and Hubbs Grimm, have been working together on gadolinium toxicity related issues since 2012 and this website since 2014.  Since it affects us and our many new friends personally, coming to agreement on our “message” has not always been easy but we have done it.

Recently, out of frustration with lack of progress on matters related to gadolinium toxicity from MRI contrast agents, we wanted to do a post that was both reflective of where the medical community has been on this issue and where we believe it ought to go.  While we had similar ideas, we differed in how we wanted to convey the message.  So, we each worked on our own editorial and then we helped each other with the final copy as we have done many times in the past.

Tomorrow we will be posting two editorials about Gadolinium Toxicity.  While our approaches are different, this is not a dispute between us or an attempt to decide which is right and which is wrong.  Instead, it is two people, working together with great respect for each other, expressing their thoughts in an important discussion about something that affects countless other people.  We invite industry representatives to contribute to this discussion.

We hope you will read both editorials and take time to consider the important points we make.

Sharon’s editorial is titled, “Gadolinium Toxicity: If not NSF, then what is it?
Hubbs’ editorial is titled, “Gadolinium Toxicity – Let’s not make the same mistake again

Sharon Williams and Hubbs Grimm
Coauthors of The Lighthouse Project

FDA makes change to GBCA Medication Guide requirement

On December 19, 2017, the FDA issued a new Safety Announcement related to gadolinium-based contrast agents (GBCAs) administered for MRIs.  One of the actions described in the announcement was the requirement that every patient be given a Medication Guide to read before receiving a GBCA.  The Medication Guides for all GBCAs are now available.  However, on May 16, 2018, the FDA issued an Update to the requirement that patients be given the Medication Guides prior to their MRIs.

It appears that the FDA has determined that, “hospital inpatients are not required to receive a Medication Guide unless the patient or caregiver requests it”.

Since most people are not aware that patients are retaining gadolinium from GBCAs administered for MRIs or that gadolinium is a toxic metal, they will not know to ask for a copy of the Medication Guide or that one even exists.  That will result in a vulnerable population of patients not being fully-informed about the potential risk of gadolinium deposition in their brain, bones, skin, and other tissues.

As documented in the medical literature, patients in hospitals are at greater risk of having an acute kidney injury or AKI which can impair patients’ kidney function and potentially cause them to retain more gadolinium.  I believe that patients in hospitals and/or their families should be informed about that risk and they should be given a Medication Guide for the GBCA that will be administered for any inpatient imaging procedures.

The following is the FDA’s May 16, 2018 Update – (more…)

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