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To determine the prevalence of nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease (CKD) who have received gadopentetate dimeglumine.We retrospectively studied all patients who underwent contrast-enhanced magnetic resonance imagings (CE-MRIs) between January 1, 2004 and May 31, 2007, in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3.3 million residents in Northern California. All patients received gadopentetate dimeglumine. We used 4 methods to discover cases of NSF: review of pathology slides, review of coded diagnosis, review of visits to dermatologists and rheumatologists, and surveys of physicians.During the study period 115,252 CE-MRIs were performed, including 676 in 530 patients receiving dialysis (92% on chronic dialysis and 8% on acute dialysis) and 3,423 in 2,862 patients with elevated serum creatinine levels at the time of gadolinium chelate administration. One dialysis patient had a definite diagnosis of NSF. In 3 additional patients, 1 on chronic dialysis and 2 with CKD, NSF could not be ruled out.The prevalence of NSF in patients with CKD who received gadopentetate dimeglumine is lower than previously reported in patients who have received less stable formulations of gadolinium chelates.The prevalence of NSF in our patient population is likely underreported as all patients were not individually examined and histology was not available in the majority of patients. Furthermore, the prevalence is likely effected by the lower average dose and frequency of gadolinium chelate administration in this study compared with previous reports in the literature.