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Multicenter Study
. 2013 Dec 9;8(12):e82037.
doi: 10.1371/journal.pone.0082037. eCollection 2013.

Nephrogenic systemic fibrosis in Denmark--a nationwide investigation

Tina R Elmholdt  1 , Anne B B Olesen  2 , Bettina Jørgensen  3 , Stinne Kvist  3 , Lone Skov  4 , Henrik S Thomsen  5 , Peter Marckmann  6 , Michael Pedersen  7
Affiliations
Multicenter Study

Nephrogenic systemic fibrosis in Denmark--a nationwide investigation

Tina R Elmholdt et al. PLoS One. .

Abstract

Background: Nephrogenic systemic fibrosis is a debilitating and painful disorder with an increased stimulation of the connective tissue in the skin and systemic tissues. The disease is associated with exposure to gadolinium-based contrast agent used in magnetic resonance imaging in patients with renal impairment.

Methods: The prevalence of nephrogenic systemic fibrosis has so far never been determined at a national level. In 2009, Denmark was the first country to design a guideline for the tracing of nephrogenic systemic fibrosis patients. The aim of this paper is to communicate the main findings of this quest.

Results: The outcome of the nationwide investigation revealed that Denmark had 65 patients with nephrogenic systemic fibrosis and thereby the highest prevalence of nephrogenic systemic fibrosis worldwide with 65 per 5.6 million inhabitants, or 12 per million.

Conclusions: The nationwide investigation in Denmark revealed the highest prevalence of NSF worldwide. This may be rooted in a high level of awareness of NSF both among doctors, politicians and, not least, the media, combined with the fact that a nationwide NSF investigation was initiated.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Clinical photos from nephrogenic systemic fibrosis patients.
A: Tightness and hardness of the hands combined with joint contractures. B: Firm nodules establishing a cobblestone configuration. C: Tight and firm skin on lower legs.
Figure 2
Figure 2. The total amount of GBCAs purchased in Denmark in the period 1998–2011.
The figure illustrates a deceleration and stagnation of GBCA consumption from 2006 and onwards. Omniscan® disappeared after 2008 and sales of Magnevist® experienced a drastic decline. Instead, Dotarem® and Gadovist® increased their marked share from 2008. Magnevist®, Optimark® and Vasovist/Ablavar® are no longer marketed in Denmark, and Primovist/Eovist® is not registrered in Denmark, leaving five of nine world-wide known agents on today's market.
Figure 3
Figure 3. Number of nephrogenic systemic fibrosis patients in Europe, showing the uneven prevalence among countries.
See this image and copyright information in PMC

References

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