Can Febuxostat Protect From Contrast Induced AKI?

Can Febuxostat Protect From Contrast Induced AKI?

Contrast induced acute kidney injury is an important concern in patients undergoing percutaneous coronary interventions due the larger volume of contrast needed in comparison to diagnostic studies. It is more likely in patients undergoing primary angioplasty for acute myocardial infarction because of greater hemodynamic instability and lack of chance for protective measures like pre-procedure hydration.

A randomized controlled trial evaluated 120 patients with stage 3 chronic kidney disease who underwent PCI for acute coronary syndrome [1]. 60 patients received Febuxostat in addition to intravenous hydration and N-acetylcysteine. Febuxostat was given 6-18 hours prior and within 6-18 hours after PCI, with a time gap of 24 hours between the doses. Control group received intravenous hydration and N-acetylcysteine.

It was found that the incidence of AKI was higher in the control group, 25% vs 11.7% in the febuxostat group. Other independent predictors for AKI in the study were diabetes mellitus, high blood urea and creatinine, CKD stage 3B, high Mehran score and high AKI risk.

Uric acid may be a potential mediator for AKI by systemic effects of uric acid and by renal effects which could be crystal dependent and crystal independent mechanisms. Uric acid can induce renin-angiotensin-aldosterone activation, increase inflammatory mediators, increase reactive oxygen species, decrease bioavailability of nitric oxide and impair renal autoregulation which can lead to decline in glomerular filtration rate. In addition to the effect of febuxostat in lowering uric acid levels, inhibitory effect on oxidative stress and inflammatory biomarkers may be another reason for the renoprotective effect of febuxostat.

Though this is a small study which can at best be considered as hypothesis forming, it gives a good base for formulating future research protocols involving larger groups of patients from multiple geographic regions.

Reference

1. 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. PMID: 36949408; PMCID: PMC10035112.