1. This randomized control trial found that febuxostat has a reno-protective effect that can reduce the incidence of contrast-induced acute kidney injury in chronic kidney disease stage 3 patients undergoing percutaneous coronary intervention
Evidence Rating Level: 1 (Excellent)
Contrast-induced acute kidney injury (CI-AKI) is considered the third most common cause of AKI in hospitalized patients. Percutaneous coronary intervention (PCI) increases the incidence of CI-AKI, which is already gradually increasing. Although 80% of patients’ creatinine values return to baseline within 1 to 3 weeks after CI-AKI, some patients develop renal failure, leading to the initiation of renal replacement therapy, cardiovascular events, and an increased mortality rate. Prior literature has suggested that Febuxostat may have renoprotective properties in its hypouricemic and anti-inflammatory effects, which are thought to combat mechanisms leading to CI-AKI. This randomized control trial aimed to evaluate the reno-protective effect of febuxostat in the prevention of CI-AKI in stage 3 CKD patients undergoing PCI. The trial enrolled 120 stage 3 CKD patients with acute coronary syndrome who were scheduled to undergo PCI at Ain-Shams University hospital. Patients were randomly assigned to two arms — one study arm consisting of 60 patients who received Febuxostat 80 mg within 6–18 h before and after the procedure with an interval of 24 h between the two doses, and a control group of 60 patients who received traditional treatment only. Patients were stratified to low, moderate, high, and very high risk of AKI according to their calculated Mehran risk score. The incidence of AKI was 25% in the control group and 11.7% in the study group (p-value = 0.048). Aside from febuxostat avoidance, the only other statistically significant independent risk factors of CI-AKI incidence were the Mehran score and baseline serum creatine. Overall, this randomized control trial demonstrates that febuxostat has reno-protective effects that can reduce CI-AKI incidence in stage 3 CKD patients undergoing PCI. Given the absence of adverse events in this study and the demonstrated protection febuxostat affords against CI-AKI, its use should be strongly considered in stage 3 CKD patients.
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