Discussion
inflammation, Diabetes, AKI, CI-AKI, diabetes
ADVERSE REACTIONS, RENAL IMPAIRMENT, CKD STAGE 3, INFLAMMATION, DIABETES, REGRESSION, EVENTS, OXIDATIVE STRESS, ALLERGIC REACTIONS, DIABETES
Besides being relatively inexpensive, our study showed that febuxostat is safe and tolerable in this patient subset. No adverse reactions occurred in the febuxostat group, including cardiovascular events and severe allergic reactions.Febuxostat is a non-purine analog xanthine oxide reductase (XOR) inhibitor that showed better organ protection than allopurinol. The superior efficacy of non-purine analog inhibitors was due to their greater inhibition of XOR activity, which reduced oxidative stress. Febuxostat has also been suggested to inhibit inflammation and apoptosis through MAPK signaling [In our study, the mean age was 60 ± 7.32 years old. However, age didn’t affect the incidence of CI-AKI this could be due to age matching between the study and control group, which is similar to the findings of a study by Ma, Li [The Febuxostat dose was 80 mg 6–18 h before and after the procedure with a time gap of 24 h between the two doses. Different doses were reported in other studies. Kamet et al. showed that the hypouricaemic effect of febuxostat was evident within an hour of drug administration. The nadir of serum urate was highly variable but was achieved at an average of 24 ± 16 h after dosage [In the current study, we used serum creatinine and estimated GFR as biomarkers for renal impairment. Estimated GFR was measured using CKD-EPI equation. The total contrast volume needed in our study was 187.25 ± 42.36 ml and both groups were comparable between both groups. This is similar to the contrast volume used for PCI in other [Diabetes was reported to be a risk factor for CI-AKI development in the current study. However, in multivariate analysis, diabetes lost its significance when adjusted to the other risk factors. Adjusted risk factors in a study by Ma, Li did not also report diabetes as significant factor [In the current study, there was a statistically significant difference between both groups regarding the incidence of CI-AKI as AKI occurred in 18.3%, including 25% in the control group and only 11.7% in the study group (Febuxostat group) (p-value: 0.048). However, Ma et al. reported that CI-AKI occurred in 10.4%, including 6% in the febuxostat group and 14.71% in the control group [There was no statistically significant difference between both groups regarding serum uric acid before and after the procedure. Contrary to our study, serum uric acid decreased significantly in the Febuxostat group in both previous studies that were performed by Ma, Li and Zhuang, Lihua [Multivariate logistic regression analysis was conducted to identify factors related to development of CI-AKI. Only baseline serum creatinine, Mehran score, and febuxostat avoidance kept their significance as independent predictors of CI-AKI incidence in the multivariate model. This result is concordant with the study of Ma, Li [As regard the use of drugs which may affect the incidence of CI AKI as SGL2I, ACEI or ARBs this come in consistency with the findings of Pavasini et al., who demonstrated that using these medications as a baseline medications is not considered as an independent predictors of CA-AKI [The study had some limitations. It is a single-center study that was confined to CKD stage 3 patients and lacked follow-up for mortality, need for dialysis or prolonged hospitalization. The study had the advantage of being prospective, randomized. Using block randomization decreases the incidence of selection bias. Sample size was adequate in comparison to the recent studies evaluating the same topic. Different risk factors were studied and adjusted to the use of Febuxostat.