A 70-year-old male with end-stage renal disease (eGFR < 15 mL/min/1.73m²) requires an MRI of the brain for suspected metastatic lesions. Which of the following statements regarding the use of gadolinium-based contrast agents (GBCAs) in this patient is most accurate?

Explanation

Patients with end-stage renal disease (eGFR < 15 mL/min/1.73m²) are at the highest risk for developing Nephrogenic Systemic Fibrosis (NSF) after exposure to gadolinium-based contrast agents (GBCAs). NSF is a rare but severe and debilitating fibrosing disorder affecting the skin and internal organs. While GBCAs do not cause contrast-induced nephropathy (Option A), the risk of NSF is a major concern. Group II GBCAs (macrocyclic agents) have a significantly lower risk of NSF compared to Group I (linear agents) but are not entirely without risk, especially in ESRD patients (Option B is incorrect). Hemodialysis immediately post-MRI (Option D) can help remove gadolinium but has not been definitively shown to prevent NSF, and the primary recommendation is to avoid GBCAs in high-risk patients if non-contrast imaging is sufficient or an alternative is available.