International Urology and Nephrology

, Volume 50, Issue 10, pp 1879–1886 | Cite as

Nephrotoxicity of iodixanol versus iopamidol in patients undergoing peripheral angiography with or without endovascular therapy

  • Hong-liang Xiong
  • Meng Peng
  • Xiong-jing Jiang
  • Hui Dong
  • Wu-qiang Che
  • Yang Chen
  • Yu-bao Zou
  • Bo Xu
  • Yue-jin Yang
  • Run-lin Gao
Nephrology - Original Paper



To compare the nephrotoxic effects of iodixanol and iopamidol in patients undergoing peripheral angiography.


Patients scheduled for peripheral angiography were randomly assigned to the iodixanol group (n = 463) and iopamidol group (n = 458). The primary endpoint was the incidence of contrast associated acute kidney injury (CA-AKI), which was defined as an increase ≥ 25% or ≥ 44.2 µmol/l (0.5 mg/dl) in serum creatinine (SCr) from baseline within 72 h after receiving contrast media (CM). The secondary endpoints were the mean peak SCr increase within 72 h after receiving CM and major adverse renal events (SCr increased by two times after 30 days, the need for dialysis treatment, rehospitalization for acute renal failure, or kidney-related death) during hospitalization and within 30 day postdischarge.


The incidence of CA-AKI did not differ significantly between the iodixanol group and iopamidol group (18.1% vs. 16.8%; p = 0.595). There was no significant difference in the mean peak SCr increase between the iodixanol group and iopamidol group (10.4 ± 13.0 vs. 10.6 ± 14.3 µmol/l, p = 0.919). There were four patients [1 (0.2%) patient in the iodixanol group and 1 (0.7%) patients in the iopamidol group, p = 0.609] with doubling of SCr; no other adverse renal events were observed.


Our data showed that the nephrotoxicity of iodixanol was comparable with that of iopamidol in patients undergoing peripheral angiography.


Contrast medium Contrast associated acute kidney injury Peripheral angiography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Azzalini L, Spagnoli V, Ly HQ (2016) Contrast-Induced Nephropathy: From Pathophysiology to Preventive Strategies. Can J Cardiol 32(2):247–255CrossRefPubMedGoogle Scholar
  2. 2.
    McCullough PA, Bertrand ME, Brinker JA, Stacul F (2006) A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol 48(4):692–699CrossRefPubMedGoogle Scholar
  3. 3.
    Dong M, Jiao Z, Liu T, Guo F, Li G (2012) Effect of administration route on the renal safety of contrast agents: a meta-analysis of randomized controlled trials. J Nephrol 25(3):290–301CrossRefPubMedGoogle Scholar
  4. 4.
    From AM, Al Badarin FJ, McDonald FS, Bartholmai BJ, Cha SS, Rihal CS (2010) Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy: meta-analysis of randomized, controlled trials. Circ Cardiovasc Interv 3(4):351–358CrossRefPubMedGoogle Scholar
  5. 5.
    Reed M, Meier P, Tamhane UU, Welch KB, Moscucci M, Gurm HS (2009) The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv 2(7):645–654CrossRefPubMedGoogle Scholar
  6. 6.
    Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ (2003) Nephrotoxicity in high-risk patients study of I-O, low-osmolar non-ionic contrast media study. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348(6):491–499 I )CrossRefPubMedGoogle Scholar
  7. 7.
    Jo SH, Youn TJ, Koo BK, Park JS, Kang HJ, Cho YS, Chung WY, Joo GW, Chae IH, Choi DJ, Oh BH, Lee MM, Park YB, Kim HS (2006) Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER Study: a randomized controlled trial. J Am Coll Cardiol 48(5):924–930CrossRefPubMedGoogle Scholar
  8. 8.
    Laskey W, Aspelin P, Davidson C, Rudnick M, Aubry P, Kumar S, Gietzen F, Wiemer M, Group DXVS. (2009) Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures. Am Heart J 158(5):822–828 e3.CrossRefPubMedGoogle Scholar
  9. 9.
    Bartholomew BA, Harjai KJ, Dukkipati S, Boura JA, Yerkey MW, Glazier S, Grines CL, O’Neill WW (2004) Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 93(12):1515–1519CrossRefPubMedGoogle Scholar
  10. 10.
    European Stroke O, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Rother J, Sievert H, van Sambeek M, Zeller T, Guidelines ESCCfP (2011) ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32(22):2851–2906CrossRefGoogle Scholar
  11. 11.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130(6):461–470CrossRefPubMedGoogle Scholar
  12. 12.
    Authors/Task F, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35(37):2541–2619CrossRefGoogle Scholar
  13. 13.
    Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, American College of Cardiology F, American Heart Association Task Force on Practice G, Society for Cardiovascular A, Interventions (2011) 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 58(24):e44–e122CrossRefPubMedGoogle Scholar
  14. 14.
    Biondi-Zoccai G, Lotrionte M, Thomsen HS, Romagnoli E, D’Ascenzo F, Giordano A, Frati G (2014) Nephropathy after administration of iso-osmolar and low-osmolar contrast media: evidence from a network meta-analysis. Int J Cardiol 172(2):375–380CrossRefPubMedGoogle Scholar
  15. 15.
    Mehran R, Nikolsky E, Kirtane AJ, Caixeta A, Wong SC, Teirstein PS, Downey WE, Batchelor WB, Casterella PJ, Kim YH, Fahy M, Dangas GD (2009) Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (ionic versus non-ionic contrast to obviate worsening nephropathy after angioplasty in chronic renal failure patients) study. JACC Cardiovasc Interv 2(5):415–421CrossRefPubMedGoogle Scholar
  16. 16.
    Peng M, Jiang XJ, Dong H, Zou YB, Song L, Zhang HM, Wu HY, Yang YJ, Gao RL (2016) A comparison of nephrotoxicity of contrast medium in elderly patients who underwent renal or peripheral arterial vascular intervention. Intern Med 55(1):9–14CrossRefPubMedGoogle Scholar
  17. 17.
    Solomon RJ, Natarajan MK, Doucet S, Sharma SK, Staniloae CS, Katholi RE, Gelormini JL, Labinaz M, Moreyra AE, Investigators of the CS (2007) Cardiac Angiography in Renally Impaired Patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease. Circulation 115(25):3189–3196CrossRefPubMedGoogle Scholar
  18. 18.
    Karlsberg RP, Dohad SY, Sheng R, Iodixanol Peripheral CTASIP. (2010) Contrast-induced acute kidney injury (CI-AKI) following intra-arterial administration of iodinated contrast media. J Nephrol 23(6):658–666PubMedGoogle Scholar
  19. 19.
    Shin DH, Choi DJ, Youn TJ, Yoon CH, Suh JW, Kim KI, Cho YS, Cho GY, Chae IH, Kim CH (2011) Comparison of contrast-induced nephrotoxicity of iodixanol and iopromide in patients with renal insufficiency undergoing coronary angiography. Am J Cardiol 108(2):189–194CrossRefPubMedGoogle Scholar
  20. 20.
    Chen Y, Hu S, Liu Y, Zhao R, Wang L, Fu G, He Q, Su X, Zheng Y, Qi X, Liu H, Wang J, Gao W, Wang M, Liu S, Zheng X, He B, Yang P, Zhou S, Gao C, Qiu C (2012) Renal tolerability of iopromide and iodixanol in 562 renally impaired patients undergoing cardiac catheterisation: the DIRECT study. EuroIntervention 8(7):830–838CrossRefPubMedGoogle Scholar
  21. 21.
    Bertrand ME, Esplugas E, Piessens J, Rasch W (2000) Influence of a nonionic, iso-osmolar contrast medium (iodixanol) versus an ionic, low-osmolar contrast medium (ioxaglate) on major adverse cardiac events in patients undergoing percutaneous transluminal coronary angioplasty: A multicenter, randomized, double-blind study. Visipaque in Percutaneous Transluminal Coronary Angioplasty [VIP] Trial Investigators Circulation 101(2):131–136PubMedGoogle Scholar
  22. 22.
    Nie B, Cheng WJ, Li YF, Cao Z, Yang Q, Zhao YX, Guo YH, Zhou YJ (2008) A prospective, double-blind, randomized, controlled trial on the efficacy and cardiorenal safety of iodixanol vs. iopromide in patients with chronic kidney disease undergoing coronary angiography with or without percutaneous coronary intervention. Catheter Cardiovasc Interv 72(7):958–965CrossRefPubMedGoogle Scholar
  23. 23.
    Safian RD, Textor SC (2001) Renal-artery stenosis. N Engl J Med 344(6):431–442CrossRefPubMedGoogle Scholar
  24. 24.
    Goel SS, Shishehbor MH (2014) Renal complications in patients undergoing peripheral artery interventions. Interv Cardiol Clin 3(3):441–448PubMedGoogle Scholar
  25. 25.
    Marraccini P, Bianchi M, Fommei E, Palmieri C, Ciriello G, Ciardetti M, Mazzarisi A, Djukic G, L’Abbate A (2010) Contrast medium nephrotoxicity after renal artery and coronary angioplasty. Acta Radiol 51(4):462–466CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Hong-liang Xiong
    • 1
  • Meng Peng
    • 2
  • Xiong-jing Jiang
    • 1
  • Hui Dong
    • 1
  • Wu-qiang Che
    • 1
  • Yang Chen
    • 1
  • Yu-bao Zou
    • 1
  • Bo Xu
    • 1
  • Yue-jin Yang
    • 1
  • Run-lin Gao
    • 1
  1. 1.Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

Personalised recommendations