Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study
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 com...
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Taylor & Francis Group
2023-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2194434 |
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| author | Ahmed Fayed Ahmed A. Hammad Dina O. Abdulazim Hany Hammad Mohamed Amin Samir Elhadidy Mona M. Salem Ibrahim M. Abd ElAzim Lajos Zsom Eva Csongradi Karim M. Soliman Usama A. Sharaf El Din |
| author_facet | Ahmed Fayed Ahmed A. Hammad Dina O. Abdulazim Hany Hammad Mohamed Amin Samir Elhadidy Mona M. Salem Ibrahim M. Abd ElAzim Lajos Zsom Eva Csongradi Karim M. Soliman Usama A. Sharaf El Din |
| author_sort | Ahmed Fayed |
| collection | DOAJ |
| description | 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 |
| format | Article |
| id | doaj-art-6e2a6c1f57724d7283554d0bc13c0d23 |
| institution | OA Journals |
| issn | 0886-022X 1525-6049 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj-art-6e2a6c1f57724d7283554d0bc13c0d232025-08-20T02:16:11ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145110.1080/0886022X.2023.2194434Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled studyAhmed Fayed0Ahmed A. Hammad1Dina O. Abdulazim2Hany Hammad3Mohamed Amin4Samir Elhadidy5Mona M. Salem6Ibrahim M. Abd ElAzim7Lajos Zsom8Eva Csongradi9Karim M. Soliman10Usama A. Sharaf El Din11Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptEndocrinology Unit, Internal Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, EgyptRheumatology and Rehabilitation Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptNephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptCritical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptCritical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptEndocrinology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptCritical Care Medicine, Theodor Bilharz Research Institute, Cairo, EgyptFresenius Medical Care Hungary, Cegléd, HungaryDepartment of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, HungaryDepartment of Surgery, Division of Transplant, Medical University of South Carolina, Charleston, SC, USANephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, EgyptBackground 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 NCT03470454https://www.tandfonline.com/doi/10.1080/0886022X.2023.2194434Post-contrast AKIDPP4IslinagliptinallopurinolN-acetyl cysteine |
| spellingShingle | Ahmed Fayed Ahmed A. Hammad Dina O. Abdulazim Hany Hammad Mohamed Amin Samir Elhadidy Mona M. Salem Ibrahim M. Abd ElAzim Lajos Zsom Eva Csongradi Karim M. Soliman Usama A. Sharaf El Din Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study Renal Failure Post-contrast AKI DPP4Is linagliptin allopurinol N-acetyl cysteine |
| title | Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study |
| title_full | Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study |
| title_fullStr | Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study |
| title_full_unstemmed | Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study |
| title_short | Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study |
| title_sort | is the combination of linagliptin and allopurinol better prophylaxis against post contrast acute kidney injury a multicenter prospective randomized controlled study |
| topic | Post-contrast AKI DPP4Is linagliptin allopurinol N-acetyl cysteine |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2194434 |
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