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Nephrogenic systemic fibrosis (NSF) is a serious disease affecting renal failure patients. It may be caused by some gadolinium (Gd)-containing contrast agents, including gadodiamide. The study aimed at estimating the prevalence of NSF after gadodiamide exposure for patients with chronic kidney disease (CKD).Retrospective cohort study of 190 consecutive nephrological patients in different categories of kidney function referred for gadodiamide-enhanced magnetic resonance imaging in the period January 1, 2004 to March 21, 2006.Eighteen patients (18/190; 10%, 95% CI: 6%–15%) were diagnosed with NSF within a mean follow-up period of 29 months (range 16–43 months). All 18 cases had stage 5 CKD (ie, estimated glomerular filtration rate less than 15 mL/min/1.73 m2 or in dialysis therapy) at the time of their gadodiamide exposure. The prevalence of NSF among patients with stage 5 CKD at exposure (n = 102) was 18% (95% CI: 11%–27%). No cases were seen among 88 gadodiamide-exposed patients who had milder degrees of renal insufficiency (prevalence 0%, 95% CI: 0%–4%).The risk of NSF is unacceptably high among stage 5 CKD patients exposed to gadodiamide.