Efficacy, safety, and optimal use of isoosmolar contrast medium (Iodixanol) in diagnostic and interventional procedures: A Thai multidisciplinary expert meeting report
DOI:
https://doi.org/10.46475/asean-jr.v27i1.966Keywords:
contrast media, osmolality, acute kidney injury, patient safetyAbstract
Contrast media are used in clinical practice for diagnostic and therapeutic purposes. To discuss the position of iso-osmolar contrast media (IOCM) in diagnostic and interventional procedures in Thailand, an expert advice meeting, including neurologists, cardiologists, nephrologists, radiologists, radiologic technologists and radiologic nurses, was organized to discuss the use of IOCM and low-osmolar contrast media, in general and in specific risk groups. Topics discussed included acute kidney injury, cardiovascular events, patient discomfort, allergic reactions, and high-risk groups. The experts agreed that IOCM has an overall beneficial safety profile as compared to low-osmolar contrast media. With the use of IOCM, patients have a low risk of allergic reactions, and a reduced risk of contrast-associated acute kidney injury. Moreover, the patient will feel less pain. Therefore, IOCM is considered particularly useful in patients at high risk of acute kidney injury, especially in procedures that involve significant contrast exposure.
Downloads
Metrics
References
Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int. 2011;79:1361-9. doi:10.1038/ki.2011.42.
Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, et al. A European Renal Best Practice (ERBP) position statement on the KDIGO clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012;27:4263-72. doi:10.1093/ndt/gfs375.
Kooiman J, Le Haen PA, Gezgin G, de Vries JP, Boersma D, Brulez HF, et al. Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration. Am Heart J. 2013;165:793-9.e1. doi:10.1016/j.ahj.2013.02.013.
Andreucci M, Faga T, Serra R, De Sarro G, Michael A. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf. 2017;9:25-37. doi:10.2147/DHPS.S122207.
Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348:491-9. doi:10.1056/NEJMoa021833.
Solomon RJ, Natarajan MK, Doucet S, Sharma SK, Staniloae CS, Katholi RE, et al. Cardiac angiography in renally impaired patients (CARE) study. Circulation. 2007;115:3189-96. doi:10.1161/CIRCULATIONAHA.106.671644.
Nguyen SA, Suranyi P, Ravenel JG, Randall PK, Romano PB, Strom KA, et al. Iso-osmolality versus low-osmolality iodinated contrast medium at IV contrast-enhanced CT. Radiology. 2008;248:97-105. doi:10.1148/radiol.2481071484.
Heinrich MC, Häberle L, Müller V, Bautz W, Uder M. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media. Radiology. 2009;250:68-86. doi:10.1148/radiol.2501080833.
Dong M, Jiao Z, Liu T, Guo F, Li G. Effect of administration route on the renal safety of contrast agents. J Nephrol. 2012;25:290-301. doi:10.5301/jn.5000067.
Zhang J, Jiang Y, Rui Q, Chen M, Zhang N, Yang H, et al. Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography. Medicine (Baltimore). 2018;97:e0617. doi:10.1097/MD.0000000000010617.
Yang X, Huang W, Liu W, Zhu Y, Xu Y, Yang G, et al. Influence of contrast agent osmolarity on iodine delivery protocol in coronary CT angiography. J Comput Assist Tomogr. 2018;42:62-7. doi:10.1097/RCT.0000000000000651.
From AM, Bartholmai BJ, Williams AW, McDonald FS. Iodixanol compared to iohexol for contrast procedures. Acta Radiol. 2008;49:409-14. doi:10.1080/02841850801901791.
Karlsberg RP, Dohad SY, Sheng R; Iodixanol Peripheral CTA Study Investigator Panel. Contrast-induced acute kidney injury following intra-arterial administration of iodinated contrast media. J Nephrol. 2010;23:658-66.
Breglia A, Godi I, Virzì GM, Guglielmetti G, Iannucci G, De Cal M, et al. Subclinical contrast-induced acute kidney injury in patients undergoing cerebral CT. Cardiorenal Med. 2020;10:125-36. doi:10.1159/000505422.
Baek J, Jeong HW, Heo YJ, Yun S, Kang M, Kim B, et al. Comparison of safety and diagnostic efficacy of iohexol, iopamidol, and iodixanol in cerebral angiography. Neurointervention. 2023;19:82-91. doi:10.5469/neuroint.2024.00129.
De Francesco M, Ronco C, Wacinski PJ, Wessely R, Hernández F, Lamotte M. Economic impact of contrast-induced acute kidney injury associated with invasive cardiology. J Med Econ. 2016;19:158-68. doi:10.3111/13696998.2015.1105809.
Keuffel E, McCullough PA, Todoran TM, Brilakis ES, Palli SR, Ryan MP, et al. Effect of MARCE incidence, procedure volume, and unit cost on hospital savings from contrast media use. J Med Econ. 2018;21:356-64. doi:10.1080/13696998.2017.1415912.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. doi:10.1186/s13643-016-0384-4.
American College of Radiology. ACR manual on contrast media [Internet]. Reston (VA): ACR Committee on Drugs and Contrast Media; 2024 [cited 2025 Dec 26]. Available from: https://www.acr.org/-/media/acr/files/clinical-resources/contrast_media.pdf
Scolari F, Ravani P. Atheroembolic renal disease. Lancet. 2010;375:1650-60. doi:10.1016/S0140-6736(09)62073-0.
Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med. 2019;380:2146-55. doi:10.1056/NEJMra1805256.
Wang Z, Wang Q, Gong X. Unveiling the mysteries of contrast-induced acute kidney injury. Toxics. 2024;12:620. doi:10.3390/toxics12080620.
Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury. Crit Care. 2013;17:204. doi:10.1186/cc11454.
Lameire N, Kellum JA; KDIGO AKI Guideline Work Group. Contrast-induced acute kidney injury and renal support. Crit Care. 2013;17:205. doi:10.1186/cc11455.
Obed M, Gabriel MM, Dumann E, Vollmer Barbosa C, Weißenborn K, Schmidt BMW. Risk of acute kidney injury after contrast-enhanced CT. Eur Radiol. 2022;32:8432-42. doi:10.1007/s00330-022-08916-y.
McDonald JS, McDonald RJ, Williamson EE, Kallmes DF. Intravenous iodixanol and risk of acute kidney injury. Radiology. 2017;285:414-24. doi:10.1148/radiol.2017161573.
Eng J, Wilson RF, Subramaniam RM, Zhang A, Suarez-Cuervo C, Turban S, et al. Comparative effect of contrast media type on contrast-induced nephropathy. Ann Intern Med. 2016;164:417-24. doi:10.7326/M15-1402.
McCullough PA, Brown JR. Effects of iso-osmolar contrast medium (iodixanol) on CI-AKI risk. Cardiorenal Med. 2011;1:220-34. doi:10.1159/000332384.
Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med. 2018;378:603-14. doi:10.1056/NEJMoa1710933.
Weisbord SD, Palevsky PM, Kaufman JS, Wu H, Androsenko M, Ferguson RE, et al. Contrast-associated acute kidney injury and adverse outcomes. J Am Coll Cardiol. 2020;75:1311-20. doi:10.1016/j.jacc.2020.01.023.
McCullough PA, Bertrand ME, Brinker JA, Stacul F. Renal safety of isosmolar iodixanol vs low-osmolar contrast media. J Am Coll Cardiol. 2006;48:692-9. doi:10.1016/j.jacc.2006.02.073.
Cheng W, Wu X, Liu Q, Wang HS, Zhang NY, Xiao YQ, et al. Post-contrast acute kidney injury in hospitalized population. Eur Radiol. 2020;30:3516-27. doi:10.1007/s00330-020-06690-3.
Chang DR, Lu SY, Lin ZH, Kuo CC, Chiang HY. Contrast-related risk of progressing to ESRD in PCI. J Am Soc Nephrol. 2023;34(11S):746-7. doi:10.1681/ASN.20233411S1746d.
Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after IV contrast media. AJR Am J Roentgenol. 2001;176:1385-8. doi:10.2214/ajr.176.6.1761385.
Barrett BJ, Parfrey PS, Vavasour HM, O'Dea F, Kent G, Stone E. Nonionic low-osmolality vs ionic high-osmolality agents. N Engl J Med. 1992;326:431-6. doi:10.1056/NEJM199202133260702.
Wei Y, Jiang X, Hibberd M, Sampedro A, Rautenbach J. Rate of acute adverse reactions to low-osmolar contrast media. Eur Radiol. 2025;35:6240-9. doi:10.1007/s00330-025-11526-z.
Müller FH. Post-marketing surveillance of iodixanol safety in outpatient CT. Rofo. 2014;186:1028-34. doi:10.1055/s-0034-1366370.
Reed M, Meier P, Tamhane UU, Welch KB, Moscucci M, Gurm HS. Relative renal safety of iodixanol. JACC Cardiovasc Interv. 2009;2:645-54. doi:10.1016/j.jcin.2009.05.002.
Hosoya T, Yamaguchi K, Akutsu T, Mitsuhashi Y, Kondo S, Sugai Y, et al. Delayed adverse reactions to iodinated contrast media. Radiat Med. 2000;18:39-45.
Hunt CH, Hartman RP, Hesley GK. Frequency and severity of adverse effects of contrast materials. AJR Am J Roentgenol. 2009;193:1124-7. doi:10.2214/AJR.09.2520.
McCullough P, Ng CS, Ryan M, Baker ER, Mehta R. Major adverse renal cardiovascular events after contrast media. Cardiorenal Med. 2021;11:193-9. doi:10.1159/000517884.
Prasad A, Amin AP, Ryan MP, Gunnarsson C, Brilakis ES. Iso-osmolar contrast media and MARCE. Catheter Cardiovasc Interv. 2022;99:1335-42. doi:10.1002/ccd.30006.
Weiland FL, Marti-Bonmati L, Lim L, Becker HC. Patient comfort between iodixanol and iopamidol. Acta Radiol. 2014;55:715-24. doi:10.1177/0284185113505277.
Rosenberg C, Martínez-Rodrigo JJ, Lonjedo Vicent E, Macho J, Lim L, Todoran TM. COMFORT II trial comparing iodixanol and iopamidol. J Invasive Cardiol. 2017;29:9-15.
McCullough PA, Capasso P. Patient discomfort with intra-arterial iodinated contrast media. BMC Med Imaging. 2011;11:12. doi:10.1186/1471-2342-11-12.
Hou QR, Gao W, Sun AM, Wang Q, Qiu HS, Wang F, et al. Contrast dose and image quality in pediatric cardiac CT. Br J Radiol. 2017;90:20160669. doi:10.1259/bjr.20160669.
Kim M, Hwang JY, Choo KS, Ryu H, Reid SNS, Kim YW, et al. Image quality of abdominopelvic CT in paediatric patients. Clin Radiol. 2019;74:896.e9-e16. doi:10.1016/j.crad.2019.06.027.
Callahan MJ, Iyer RS, Wassner AJ. Thyroid monitoring after iodine-based contrast media. AJR Am J Roentgenol. 2023;220:144-5. doi:10.2214/AJR.22.28007.
Paltiel HJ. Contrast-induced nephropathy in hospitalized children. Radiology. 2020;294:557-8. doi:10.1148/radiol.2019192666.
Gilligan LA, Davenport MS, Trout AT, Su W, Zhang B, Goldstein SL, et al. Risk of acute kidney injury following contrast-enhanced CT in pediatric patients. Radiology. 2020;294:548-56. doi:10.1148/radiol.2020191931.
Dennhardt N, Schoof S, Osthaus WA, Witt L, Bertram H, Sümpelmann R. Acid-base balance alterations from hyperosmolar contrast medium. Paediatr Anaesth. 2011;21:1119-23. doi:10.1111/j.1460-9592.2011.03706.x.
Wright NB, Carty HM, Sprigg A, Kampenes VB, Friis M, Petersen KK, et al. Iodixanol in paediatric gastrointestinal imaging. Br J Radiol. 2002;75:127-35. doi:10.1259/bjr.75.890.750127.
Kume K, Yasuoka Y, Adachi H, Noda Y, Hattori S, Araki R, et al. Impact of CI-AKI in STEMI patients undergoing PCI. Cardiovasc Revasc Med. 2013;14:253-7. doi:10.1016/j.carrev.2013.07.009.
Terrenato I, Sperati F, Musicco F, Pozzi AF, di Turi A, Caterino M, et al. Iodixanol versus iopromide in cancer patients. J Cell Physiol. 2018;233:2572-80. doi:10.1002/jcp.26132.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The ASEAN Journal of Radiology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Disclosure Forms and Copyright Agreements
All authors listed on the manuscript must complete both the electronic copyright agreement. (in the case of acceptance)
