How to avoid nephrogenic systemic fibrosis: current guidelines in Europe and the United States

Views vary about how to avoid nephrogenic systemic fibrosis (NSF). In Europe, it is contraindicated to use gadodiamide, gadopentetate dimeglumine, and gadovertisamide in patients who have a glomerular filtration rate (GFR) of less than 30 mL/min, and these agents may only be used with caution in patients who have a GFR between 30 and 60 mL/min. Similar restrictions have not been introduced for the other six gadolinium-based contrast agents available in the European market. In the United States, the US Food and Drug Administration introduced a class ban and warned about the use of gadolinium-based contrast agents in patients who have reduced renal function. However, European and American guidelines about how to avoid NSF are generally not very different.