Gadoterate meglumine injection (CLARISCAN)

NSF risk is greatest with acute kidney injury or severe chronic disease with GFR below 30. Avoid gadolinium in these circumstances unless the required diagnostic information is essential and unavailable through suitable alternatives. Screen for impaired elimination, do not exceed the recommended dose, and allow elimination before repeat exposure. For patients already receiving hemodialysis, the source says prompt dialysis may be considered to enhance clearance, but whether this prevents NSF is unknown. This is not an instruction to start dialysis in a nondialysis patient.

The consensus weighs the very low NSF risk of its group II agents against harm from withholding an essential examination. In AKI or eGFR below 30, delaying appropriate contrast imaging can pose greater harm. The abstract says initiating or changing dialysis solely because of group II/III administration is likely unnecessary. These are dated consensus statements, not a claim that every gadolinium agent is low-risk or that product-specific contraindications disappear. Only the primary-publication abstract was accessible through the authors' institutional repository; full-text tables were not independently re-reviewed.

For patients already receiving dialysis, this policy seeks hemodialysis as soon as practical after contrast MRI, preferably within 24 hours, and notes that the normal outpatient schedule may need coordination with nephrology. It does not recommend switching peritoneal dialysis to hemodialysis or initiating prophylactic dialysis in nondialysis CKD. Dialysis does not guarantee protection from NSF. This institutional scheduling approach differs from the later ACR-NKF consensus wording about changing dialysis; keep the publication context and local coordination requirements visible.