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Magnetic Resonance Imaging in ESRD Patients: What are the Options?

Magnetic resonance imaging (MRI) is a powerful imaging modality. This technique has evolved over time into a uniquely sensitive and accurate diagnostic tool. In the clinical arena, it often provides information that can’t be obtained using other noninvasive imaging modalities. MRI with gadolinium-based contrast (GBC) is generally preferred over computed tomography (CT) scan for accurate imaging of various organs (Table 1). As such, MRI with or without angiography (MRI/A) has revolutionized diagnostic testing in many patients, including those with varying levels of acute and chronic kidney disease (CKD) as well as end-stage renal disease (ESRD) patients on dialysis. MRI, even with GBC became a widely employed modality in this group of patients as a result of its perceived “safety” in patients who were at risk for iodinated radiocontrast nephrotoxicity (1). This safety rationale was applied to patients with acute kidney injury (AKI), CKD, and dialysis-requiring ESRD patients who still maintained significant residual renal function. As such, this imaging option was attractive to nephrologists as it provided an accurate alternative diagnostic tool for patients who were otherwise considered too risky for radiocontrast exposure.