In a hospitalized patient who undergoes a MRI with gadolinium contrast study, would you perform hemodialysis if they have AKI with prior dialysis requirements but do not currently otherwise meet criteria for dialysis?

I would not. Although gadolinium contrast has been associated with nephrogenic systemic fibrosis in patients with advanced CKD or AKI, the risk is much lower for the newer generation contrast agents with more tightly chelated Gd. That said, the risk is not zero, as reviewed in a recent CJASN perspec...