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Nephrogenic fibrosing dermopathy (NFD), a hardening of the skin that may progress to immobility occurring in patients with renal disease, was first described by Cowper and colleagues in 2000. The CDC was unable to study the initial cluster, and, since then, toxin exposure has been suggested as a cause. Studies in Europe, particularly Denmark, pointed to the contrast agent gadolinium as a possible factor. Investigators at Mayo Clinic reported an association between use of higher doses of erythropoietin and NFD development.
Reports of a cluster of NFD cases in St. Louis prompted an investigation by the CDC and the Missouri Department of Health and Senior Services. The investigators collected data on patient demographics, hospital admissions, e…