Administering the uric-acid lowering drug allopurinol before contrast medium exposure may reduce the risk for contrast nephropathy in patients with chronic kidney disease (CKD). Investigators presented early trial results at the European Renal Association (ERA) 59th Congress held in Paris, France, and virtually.
“Allopurinol may be a potential agent for nephrologists treating patients with CKD stage 3 and higher who need to undergo contrast studies,” first author Muhammad Sajid Rafiq Abbasi, MBBS, of PAF Hospital in Islamabad, Pakistan, said in an interview. “Allopurinol was more effective in the group with high uric levels.”
Dr Abbasi and colleagues randomly assigned 76 adults to saline hydration (0.5 mL/kg/h for 12 hours before and after contrast) with or without a single oral dose of 300 mg allopurinol at 12 hours before contrast exposure. All patients had an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 and were scheduled to undergo coronary intervention.
Contrast nephropathy, a serum creatinine rise of more than 25% (or more than 0.05 mg/dL) from baseline at 48 hours after contrast exposure, occurred in a significantly lower proportion of the allopurinol than no allopurinol group (5.3% vs 21.1%). In a subgroup analysis of patients who had elevated serum uric acid levels at baseline, allopurinol recipients had a significantly lower rate of contrast nephropathy than nonrecipients (11.1% vs 71.4%). The addition of allopurinol, a xanthine oxidase inhibitor, was significantly better at reducing contrast nephropathy risk than saline hydration alone among patients with elevated serum uric acid, Dr Sajid Abbasi’s team reported. The contrast nephropathy rate did not differ significantly for patients with normal serum uric acid levels.
Contrast dose and contrast volume (CV) were comparable between groups. The mean maximal allowable contrast dose (MACD) in the allopurinol and no allopurinol group was 323.3 vs 313.4 mL. The mean contrast volume was 55.1 vs 56.9 mL, respectively. The mean CV/MACD ratio also appeared similar: 0.17 vs 0.19.
Dr Sajid Abbasi and his team are planning to conduct a large clinical trial to further test allopurinol use before contrast exposure.
Sajid Abbasi M, Sultan K, Sajjad Z. Effect of allopurinol versus saline hydration in preventing contrast-induced nephropathy. Presented at: ERA 59th Congress; May 19-22, 2022. Abstract MO351.