Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Fayed A.; Hammad A.A.; Abdulazim D.O.; Hammad H.; Amin M.; Elhadidy S.; Salem M.M.; ElAzim I.M.A.; Zsom L.; Csongradi E.; Soliman K.M.; Sharaf El Din U.A.

Journal: Renal Failure

Publisher: Taylor and Francis Ltd.

Publication Date: 28 March 2023

Volume / Issue: Volume 45 / Issue 1

Article No.: 2194434

ISSN: 0886022X

DOI: 10.1080/0886022X.2023.2194434

Scopus: View on Scopus

PubMed: 36974638

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Fayed A., Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; Hammad A.A., Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt; Abdulazim D.O., Rheumatology and Rehabilitation Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; Hammad H., Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; Amin M., Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; Elhadidy S., Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; Salem M.M., Endocrinology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt; ElAzim I.M.A., Critical Care Medicine, Theodor Bilharz Research Institute, Cairo, Egypt; Zsom L., Fresenius Medical Care Hungary, Cegléd, Hungary; Csongradi E., Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Soliman K.M., Department of Surgery, Division of Transplant, Medical University of South Carolina, Charleston, SC, United States; Sharaf El Din U.A., Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt

Abstract

Background: Patients with diabetic kidney disease (DKD) are at increased risk to develop post-contrast acute kidney injury (AKI). Diabetic patients under dipeptidyl peptidase 4 inhibitors (DPP4Is) experience a lower propensity to develop AKI. We speculated that linagliptin as a single agent or in combination with allopurinol may reduce the incidence of post-contrast AKI in stage 3–5 chronic kidney disease (CKD) patients with underlying DKD. Methods: Out of 951 DKD patients eligible for this study, 800 accepted to sign informed consent. They were randomly allocated to 4 equal groups that received their prophylaxis for 2 days before and after radiocontrast. The first control group received N-acetyl cysteine and saline, the 2nd received allopurinol, the 3rd group received linagliptin, and the 4th received both allopurinol and linagliptin. Post-procedure follow-up for kidney functions was conducted for 2 weeks in all patients. Results: 20, 19, 14, and 8 patients developed post-contrast AKI in groups 1 through 4, respectively. Neither linagliptin nor allopurinol was superior to N-acetyl cysteine and saline alone. However, the combination of the two agents provided statistically significant renal protection: post-contrast AKI in group 4 was significantly lower than in groups 1 and 2 (p < 0.02 and <0.03, respectively). None of the post-contrast AKI cases required dialysis. Conclusion: Linagliptin and allopurinol in combination may offer protection against post-contrast AKI in DKD exposed to radiocontrast. Further studies are needed to support this view. Trial registration ClinicalTrials.gov: NCT03470454. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Keywords

allopurinol; DPP4Is; linagliptin; N-acetyl cysteine; Post-contrast AKI; Acute Kidney Injury; Cysteine; Diabetic Nephropathies; Humans; Kidney Failure, Chronic; Prospective Studies; Renal Insufficiency, Chronic; acetylcysteine; creatinine; hemoglobin A1c; iohexol; iopromide; sodium chloride; urea; uric acid; acute kidney failure; adult; albumin to creatinine ratio; Article; body mass; chronic kidney failure; clinical feature; contrast induced nephropathy; controlled study; coronary angiography; creatinine blood level; cross-sectional study; diabetic nephropathy; disease duration; estimated glomerular filtration rate; female; follow up; glomerulus filtration rate; human; kidney function; kidney function test; major clinical study; male; middle aged; multicenter study; observational study; prophylaxis; prospective study; randomized controlled trial; renal protection; urea blood level; urea nitrogen blood level; clinical trial

Citation Information

Scopus Citations: 1

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