Two cases of iodixanol-induced pancreatitis

Because of the escalating number of patients on dialysis and the increased use of vascular access surveillance, more and more hemodialysis patients are undergoing angiographic procedures for angioplasty and thrombectomy of their vascular access. Such procedures expose these patients to radiographic contrast agents (RCAs). Even though, newer low-osmolar and iso-osmolar nonionic RCAs, which are associated with fewer adverse effects, are increasingly used, these agents can still cause complications. We report two cases of pancreatitis in end-stage renal disease (ESRD) patients, associated with intravenous use of the iodixanol. Although RCAs have been reported to exacerbate experimentally induced pancreatitis in animals [1] and possibly prolong the clinical course of acute pancreatitis in humans [3,4], there are no documented cases of intravascular RCA inducing pancreatitis in humans. In the cases below, the RCAs used are iodixanol-320 (iso-osmolar, nonionic dimer with iodine concentration 320 mg/ml) and iohexol-300 (low-osmolar nonionic monomer with iodine concentration 300 mg/ml). The amount of RCA used during the angiogram and thrombectomy of a dialysis access is between 90 and 110 cc per study. The amount of RCA used for the contrast-enhanced computed tomography (CECT) is 140–150 cc per study.