Inequity of access to contrast-enhanced cardiovascular magnetic resonance in patients with chronic kidney disease: A survey from the British Society of Cardiovascular Magnetic Resonance.

Abstract

Objectives: To examine the provision of cardiovascular magnetic resonance (CMR) using gadolinium-based contrast agents (GBCA) in patients with chronic kidney disease (CKD).

Methods: An electronic survey was sent to the service leads of all CMR units in the UK in October 2022 requesting information on current departmental protocols and practice.

Results: A response rate of 55% was achieved from the 82 UK CMR units surveyed. There were no known cases of nephrogenic systemic fibrosis (NSF) reported within the past 10 years. Just under half the centers (22 out of 45, 49%) routinely require an estimated glomerular filtration rate (eGFR) in patients before performing contrast-enhanced CMR. Conversely, 18% (8/45) of units do not check eGFR, 20% (9/45) only require an eGFR in patients aged >65 years, while 33% (15/45) assess eGFR in patients known to have CKD. All centers use group II GBCAs: the majority (36/45, 80%) favoring gadobutrol (Gadovist), while gadoterate meglumine (Dotarem) is used in most of the remaining units (8/45, 18%). One in five centers (9/45, 20%) do not currently offer contrast-enhanced CMR to patients with an eGFR <30mL/min/1.73m². Of the CMR units that do offer contrast to this group of patients, 28% (10/36) do not obtain consent for the risk of nephrogenic systemic fibrosis.

Conclusions: One in five centers across the UK do not offer contrast-enhanced CMR to patients with stage 4 and 5 CKD. This finding serves as a call for updated guidance with the intention of standardizing care.