Results
CKD, diabetes mellitus, acute coronary syndrome, AKI, CI-AKI
REGRESSION, DIABETES MELLITUS, ACUTE CORONARY SYNDROME, CKD STAGE 3
We enrolled 120 CKD stage 3 patients with acute coronary syndrome referred to the cardiology department, Ain shams university hospital for performing PCI. We used block randomization technique to randomize subjects into groups that result in equal sample sizes. Patients were randomized into two arms (control group & study group). Each arm consisted of 60 patients. The control group received IV hydration and N-acetylcysteine. The study group received IV hydration, N-acetylcysteine and febuxostat (Fig. 
CONSORT flow diagramThe baseline demographics and associated co-morbidities were well balanced between both groups. There were no significant differences between both groups regarding the demographics and associated comorbidities. There were no significant differences between both groups regarding baseline laboratory results. In addition, there were no significant differences regarding baseline ACEI, ARBS or SGLT2 inhibitors administration. (Table 
Comparison between cases and controls concerning demographics and associated comorbidities, baseline laboratory investigations, and baseline relevant medicationst= -1.64p = 0.105Gender, No. (%)MaleFemale32 (53.3%)28 (46.7%)32 (53.3%)28 (46.7%)Xp = 1.00t= -0.46p = 0.506Xp = 0.709Xp = 0.8Xp = 0.8 F = 0.035p = 0.8 F = 0.035p = 0.8 F = 0.035p = 0.8Urinalysis No. (%)- Proteinuria- Hematuria- Pus cells33 (55%)14 (23.33%)16 (26.67%)29 (48.33%)17 (28.33%)21 (35%)0.770.20.251.640.70.67XXXt= -1.39p = 0.16t = 1.48p = 0.13t= -0.095p = 0.33t= -0.18p = 0.848t= -0.45p = 0.656t = 1.17p = 0.276t= -1.19p = 0.230t= -0.51p = 0.61t= -0.196p = 0.9t= -0.52p = 0.598t = 0.18p = 0.862t = 0.053p = 0.1t= -0.21p = 0.2t= -0.22p = 0.823t= -0.91p = 0.351t = 0.86p = 0.440t = 0.56p = 0.15t= -0.6p = 0.543CKD stage, No. (%)Stage 3 AStage 3B41 (68.3)19 (31.7)34 (56.7)26 (43.3)Xp = 0.258Xp = 0.57Xp = 0.56Xp = 0.69XIn the study group, there were no statistically significant difference between pre- and post- contrast exposure as regards serum, urea, creatinine and uric acid (Table 
Comparison between both groups as regards renal function tests after contrastt = 3.9
t = 3.12
t= -0.93p = 0.5
Comparison of renal function parameters in the study group between before and after contrastt = 2.09
t = 1.56p = 0.23t = 0.299p = 0.76It is worth mentioning that there was statistically significant difference between both groups regarding post-contrast urea (p-value: 0.006) and creatinine (p-value: 0.02) as urea and creatinine were higher among control group. While there was no statistically significant difference as regard uric acid (p value:0.5) as shown in (Table 
Comparison of renal function parameters in the control group between before and after contrastt = 6.25
t = 3.57
t = 32p = 0.824As regard the degree of change in creatinine and urea before and after contrast, there was statistically significant difference between both groups (p value: 0.0001) but there was no significant change between both groups as regard uric acid (Table 
Comparison between degree of changes in renal function parameters in both groupst = 4.7
t = 18.37
t = 4.1
There was no statistically significant difference between both groups regarding the calculated Mehran score and the predicted CI-AKI-risk. However, the incidence of AKI was significantly lower in the study group (p value: 0.048), as shown in (Table 
The difference between Study and control groups concerning CKD stage and volume of contrast administrated for all patientst = 0.57p = 0.128t= -0.38p = 0.582t= -1.45p = 0.139X
XAccording to the incident CI-AKI, the whole study population (120 patients) was divided into two groups, the CI-AKI group (22 patients) and the non-CI-AKI group (98 patients). We subsequently compared both groups regarding demographics, co-morbidities, baseline laboratory investigations, baseline relevant medications including Febuxostat use, contrast volume, Mehran score and predicted CI-AKI-risk (Table 
Univariate analysis of factors affecting CI-AKIt= -1.095p = 0.299
MaleFemale12 (54.5%)10 (45.5%)52 (53.1%)46 (46.9%)Xp = 0.9t = 0.71p = 0.51X
Xp = 0.08Xp = 0.3 F = 0.08p = 0.7Xp = 0.4t= -2.4
t= -6.22
t= -0.466p = 0.471t = 0.073p = 0.930t = 0.53p = 0.604t = 0.23p = 0.823t = 0.76p = 0.449t = 3.69

3 A3B8 (36.4%)14 (63.6%)67 (68.4%)31 (31.6%)X
Xp = 0.45Xp = 0.83Xp = 0.8X
t= -0.31p = 0.758



There were no statistically significant differences between both groups regarding demographics and comorbidities except for diabetes mellitus which was significantly more frequent in the CI-AKI group (p-value: 0.009).Regarding the renal function parameters, preprocedural serum creatinine and urea were significantly higher among the CI-AKI group (p-value: 0.0001; 0.017, respectively). while eGFR was significantly lower among the CI-AKI group (p value: 0.0001). In addition, a significantly higher proportion of the CI-AKI group was in stage 3B at baseline compared to the non-CI-AKI group with a higher proportion in stage 3 A (p = 0.005). However, both groups had no statistically significant difference in serum uric acid.Regarding relevant preprocedural medications, although there were no statistical differences between both groups as regards ACEI, ARBs or SGLT2 inhibitors, the proportion of patients who received Febuxostat peri procedurally was significantly higher among the non-CI-AKI group (p-value: 0.048). As regards procedural contrast, both groups were comparable (p = 0.758).The Mehran score and predicted CI-AKI-risk were significantly higher in the CI-AKI group (both with p-value 0.001) (Table From the previous analysis, eight risk factors for AKI were reported. These risk factors then were analyzed using multi-variate regression analysis. Three factors were able to keep their significance as independent predictors for occurrence of CI-AKI: febuxostat avoidance (p-value: 0.048), baseline serum creatinine (p-value: 0.0001) and Mehran score (p-value: 0.027) (Table 
Multiple logistic regression analysisCI = confidence interval; OR = Odds Ratio.