What type of agent would you suggest for a patient with an eGFR of 25 when considering GBCM?

The recommendation for using a macrocyclic agent in a patient with an estimated glomerular filtration rate (eGFR) of 25 is based on the higher safety profile associated with macrocyclic gadolinium-based contrast agents (GBCM). Macrocyclic agents possess a stable structure that is less likely to release free gadolinium into the body compared to linear agents.

In patients with impaired kidney function, such as those with an eGFR of 25, there is an increased risk for gadolinium retention and potential toxicity. This condition can lead to nephrogenic systemic fibrosis (NSF), a serious condition associated with the use of certain gadolinium-based contrast agents. Because macrocyclic agents are known for their reduced propensity to cause such complications, they are preferred in patients with impaired renal function.

Using macrocyclic agents in these cases helps to minimize risk while still allowing for necessary imaging. Thus, when considering the patient's renal status, the macrocyclic agent emerges as the most appropriate choice, aligning with best practices and guidelines for MRI contrast use in at-risk populations.