Richard N. Hellman, MD
Potential Financial Conflicts of Interest: None disclosed.
Hellman R.; Erythropoietin, Gadolinium, and Nephrogenic Fibrosing Dermopathy. Ann Intern Med. 2007;146:229-230. doi: 10.7326/0003-4819-146-3-200702060-00017
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Published: Ann Intern Med. 2007;146(3):229-230.
TO THE EDITOR:
I read with great interest the article by Swaminathan and colleagues (1) on the possible role of erythropoietin in 22 patients with nephrogenic fibrosing dermopathy. Of interest were the temporal relationship to erythropoietin use, apparent association compared with a control group of higher doses of erythropoietin, and improvement in some patients with erythropoietin dosage reduction. Recent advisories from the U.S. Food and Drug Administration (2) and the Danish Medicines Agency (3) and an article by Grobner (4) have suggested an association between nephrogenic fibrosing dermopathy and gadolinium use in patients with stage 5 or 6 chronic kidney disease and metabolic acidosis. This was particularly apparent when higher doses of gadolinium containing compounds were used in tests, such as magnetic resonance angiography. I am very interested to know whether any of the 22 patients used gadolinium within 3 months before the development of nephrogenic fibrosing dermopathy. In addition, I wonder whether a denominator is available for the 22 patients with diagnosed nephrogenic fibrosing dermopathy to ascertain the incidence and prevalence of this problem. I agree with the authors that erythropoietin resistance in patients with nephrogenic fibrosing dermopathy may be a marker of inflammation rather than a cause. Also, a combination of factors may be causative in nephrogenic fibrosing dermopathy.
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