Nephrogenic systemic fibrosis is associated with hypophosphataemia: a case-control study

UMMS Affiliation

Department of Medicine, Division of Rheumatology

Publication Date


Document Type



Aged; Case-Control Studies; Contrast Media; Female; Gadolinium; Humans; Hypophosphatemia; Male; Middle Aged; Nephrogenic Fibrosing Dermopathy; Renal Insufficiency, Chronic; Risk Factors


Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases


OBJECTIVE: Nephrogenic systemic fibrosis (NSF) is an iatrogenic fibrosing disorder that primarily affects individuals with chronic kidney disease (CKD) following exposure to gadolinium-based contrast agents (GBCAs). Derangements of calcium and phosphorus have been reported in patients with NSF. The aim of this study was to investigate potential factors in addition to GBCA exposure that may be involved in the pathogenesis of NSF. We hypothesized that patients with stage 5 CKD and NSF would manifest greater alterations in calcium, phosphorus and fibroblast growth factor 23 (FGF23) levels than those who do not have NSF.

METHODS: Levels of phosphorus, calcium, FGF23 and 25-hydroxy-vitamin D were measured in 10 patients with stage 5 CKD and biopsy-proven NSF and in 19 patients with stage 5 CKD without NSF. Statistical analyses were performed using Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables.

RESULTS: Patients with NSF had significantly lower phosphorus levels compared with controls (P = 0.01). There were no significant differences between NSF patients and controls in calcium, 25-hydroxy-vitamin D, intact parathyroid hormone or FGF23 levels.

CONCLUSION: Differences in phosphorus metabolism may exist between patients with stage 5 CKD and NSF compared with patients with stage 5 CKD without NSF. British Society for Rheumatology. All rights reserved.

DOI of Published Version

10.1093/rheumatology/keu151 Epub 2014 Apr 4


Bernstein EJ, Isakova T, Sullivan ME, Chibnik LB, Wolf M, Kay J. Nephrogenic systemic fibrosis is associated with hypophosphataemia: a case-control study. Rheumatology (Oxford). 2014 Sep;53(9):1613-7. doi: 10.1093/rheumatology/keu151. Epub 2014 Apr 4. PubMed PMID: 24706993; PubMed Central PMCID: PMC4135584. Link to article on publisher's site

Journal/Book/Conference Title

Rheumatology (Oxford, England)

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