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Hemodialysis Could Prevent NSF

A new study says that NSF could be prevented in some kidney patients if they undergo hemodialysis following an MRI with a gadolinium contrast dye. The authors of the study, which was published in the journal Radiology, the authors of the study concluded that kidney patients undergoing an MRI with gadolinium should be screened for their level of kidney function, and when appropriate, should undergo hemodialysis shortly after the imaging study.

Researchers from the Weill Medical College of Cornell University and Columbia University’s College of Physicians and Surgeons in New York analyzed cases of biopsy-confirmed NSF among patients who received a gadolinium-based contrast agent between January 1, 1997, and June 30, 2007. In total, there were 31 biopsy-confirmed cases of NSF in 10 men and 21 women. The patients ranged in age from 13 to 82 years.

They found that hemodialysis helped prevent NSF in patients with an estimated glomerular filtration rate (eGFR)- a measure of kidney function - of less than 15 mL/min. Increased risk of NSF was associated with patients with an eGFR of less than 30 mL/min who received a higher dose of gadolinium contrast dye, and who also experienced acute renal failure, delayed hemodialysis after contrast agent injection, proinflammatory events, and hyperphosphatemia, a condition where there is abnormally elevated level of phosphate in the blood.

Eleven of 69 patients with acute renal failure who received a high dose of the gadolinium agent when their creatinine level was increasing developed NSF when hemodialysis was delayed for more than two days.

Tennessee Woman Wins Right to Promising NSF Treatment

TennCare, Tennesee’s Medicaid managed care plan for uninsured kids and the disabled, will pay for a woman with Nephrogenic Systemic Fibrosis (NSF) to undergo photopheresis. For two years, TennCare had refused to cover the treatments for Jeanie Deason, saying it was experimental.

Extracorporeal photopheresis involves removing blood from a patient’s body, exposing it to ultraviolet light and then re-infusing the blood into the body. It’s believed that the treated blood alters the body’s immune system so it can better fight the disease. It can cost around $8000 for one treatment.

Deason’s physician, Dr. John Zic, has treated four patients with photopheresis. In all, three of Zic’s patients improved and one died because of issues with dialysis treatment, not because the treatment was ineffective.

But TennCare steadfastly refused to pay for the photopheresis for Deason. So for the past two years, she has been fighting the insurer. Finally, in April a judge ordered TennCare to cover the treatment, because it is medically necessary. Now it appears TennCare won’t appeal the judge’s decision.

In the two year’s she has been fighting TennCare, Deason’s condition has deteriorated dramatically. Her legs and right arm have become frozen in a bent position, and she needs someone with her around the clock. Now she spends her days in bed in constant pain. All of which might have been avoided if TennCare had shown a little more compassion, and paid for her photopheresis two years ago.

Deason is hoping that photopheresis will eventually allow her to walk again. But she also knows her chances would have been better if she had been able to start treatment before her NSF progressed to the point that it has.

Dozens of NSF Lawsuits Consolidated

Dozens of lawsuits have been filed against the makers of gadolinium contrast dyes by the victims of Nephrogenic Systemic Fibrosis (NSF). In February 2008, the U. S. Judicial Panel on Multidistrict Litigation designated the U.S. District Court for the Northern District of Ohio as the venue for the many lawsuits that have been filed against the makers of gadolinium contrast dyes. The cases - those already filed, and those that will be filed in the future - were assigned to District Judge Dan Polster in Cleveland, Ohio.

The Judicial Panel on Multidistrict Litigation of the United States Courts was created in 1968. Since then, it has consolidated hundreds of thousands of lawsuits that involved high numbers of plaintiffs, including litigation over asbestos, breast implants and other matters.

Multidistrict Litigation is not the same as a class action lawsuit. Each case in a Multidistrict Litigation retains its own identity. If the Multidistrict Litigation process does not resolve the cases, they are transferred back to the court where they originated for trial.

The plaintiffs in the multidistrict gadolinium litigation contend that the manufacturers of gadolinium contrast dyes knew, or should have known, the risks these drugs posed. The plaintiffs also contend that the chemical make-up of gadolinium contrast dyes makes it more likely that gadolinium will become free within the bodies of recipients, thereby making it more likely that kidney patients will develop NSF.

Lawsuits filed against these manufacturers also claim that the defendants had a duty to warn of these risks, which would have led medical practitioners to perform inexpensive kidney function test prior to performing procedures with gadolinium contrast dyes.