Although gadolinium agents have proved useful for patients with kidney impairment, in patients with severe kidney failure requiring dialysis there is a risk of a rare but serious illness, nephrogenic systemic fibrosis, which may be linked to the use of certain gadolinium-containing agents. The most frequently linked is gadodiamide, but other agents have been linked too. Although a causal link has not been definitively established, current guidelines in the United States are that dialysis patients should only receive gadolinium agents where essential and that dialysis should be performed as soon as possible after the scan to remove the agent from the body promptly.