Febuxostat has protective effect against contrast induced AKI

A new study published in BMC Nephrology suggests that febuxostat has renal protective effects and may help reduce the incidence of Contrast-induced acute kidney injury (CI-AKI) in chronic kidney disease (CKD) stage 3 patients undergoing percutaneous coronary intervention (PCI). 

Contrast-induced acute kidney injury can be a complication of intravascular contrast injection. Unfortunately, this is associated with adverse outcomes such as prolonged hospitalization and increased healthcare costs. Therefore, Iman Ibrahim Sarhan and team conducted this study to determine the efficacy of febuxostat in preventing contrast-induced acute kidney injury in patients with stage 3 CKD undergoing percutaneous coronary intervention. 

A randomized controlled trial included 120 patients with CKD stage 3 acute coronary syndrome referred to the cardiology department of Ain-Shams University Hospital for PCI and stenting. Patients were randomly divided into two groups: Group I (study group): included 60 patients who received febuxostat in addition to standard treatment (iv hydration and N-acetylcysteine). Patients received Feburic 80 mg 6 to 18 hours before and 6 to 18 hours after the coronary procedure (24-hour interval between two doses). Group II (control group): included 60 patients who received only conventional treatment.

The key findings of this study were:

The incidence of AKI was higher in the control group with a statistically significant difference. 

It was found that febuxostat avoidance, DM, high urea level, high creatinine level, chronic disease stage 3B, high Mehran score and high risk of AKI were independent significant risk factors leading to AKI. 

In conclusion, this study showed that febuxostat has a renoprotective effect. This may reduce the incidence of CI-AKI in CKD stage 3 patients undergoing PCI. Despite limited studies on the use of febuxostat for protection against CI-AKI in patients with CKD, researchers recommend its use in patients with stage 3 CKD, especially in patients with hyperuricemia. In acute kidney injury risk scores, it is recommended to stratify patients before contrast administration in CKD patients and individualize contrast agent type, volume, and preventive measures according to the results of these scores.

Reference: 

Sarhan, I. I., Abdellatif, Y. A., Saad, R. E., & Teama, N. M. (2023). Renoprotective effect of febuxostat on contrast-induced acute kidney injury in chronic kidney disease patients stage 3: randomized controlled trial. In BMC Nephrology (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-023-03114-4