Febuxostat reduces the risk for contrast-induced acute kidney injury (AKI) in patients with stage 3 chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome.
In a trial, investigators randomly assigned 120 patients to receive traditional treatment with intravenous hydration and N-acetylcysteine with and without the addition of febuxostat. The intervention group received 80 mg febuxostat 6-18 hours before and after PCI and stenting with 24 hours in between doses.
Contrast-induced AKI occurred in a significantly lower proportion of the febuxostat than control group: 11.7% vs 25%, Nahla Mohamed Teama, MD, of Ain Shams University in Cairo, Egypt, and colleagues reported in BMC Nephrology. They noted that no serious adverse reactions occurred in the febuxostat group.
Serum uric acid levels did not change significantly from baseline to 3-5 days after contrast exposure in either group, but urea and serum creatinine levels rose significantly higher in the control group. In multivariate analysis, only febuxostat nonuse, baseline serum creatinine, and high Mehran score predicted contrast-induced AKI. The Mehran Score gives points for hypotension, use of an intra-aortic balloon pump, congestive heart failure, age older than 75 years, anemia, diabetes, contrast media volume, and estimated glomerular filtration rate less than 60 mL/min/1.73m2.
Even mild hyperuricemia may increase the risk for AKI via pro-inflammatory and anti-angiogenic mechanisms, Dr Teama and colleagues. Febuxostat may help protect the kidneys by lowering urate and inhibiting oxidative stress and inflammation.
“Despite the limited studies regarding the use of [f]ebuxostat in protection against CI-AKI among CKD patients, we recommend its use in CKD stage 3 patients, especially patients with hyperuricemia,” the investigators wrote. “We recommend using risk scores for acute kidney injury before giving contrast to CKD patients to stratify the patients and individualize contrast type, volume and preventive measures according to the results of these scores.”
Sarhan II, Abdellatif YA, Saad RE, Teama NM. Renoprotective effect of febuxostat on contrast-induced acute kidney injury in chronic kidney disease patients stage 3: randomized controlled trial. BMC Nephrol. 2023 Mar 22;24(1):65. doi:10.1186/s12882-023-03114-4