Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study
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
Affiliations
Ahmed Fayed
Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Ahmed A. Hammad
Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
Dina O. Abdulazim
Rheumatology and Rehabilitation Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Hany Hammad
Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Mohamed Amin
Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Samir Elhadidy
Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Mona M. Salem
Endocrinology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
Ibrahim M. Abd ElAzim
Critical Care Medicine, Theodor Bilharz Research Institute, Cairo, Egypt
Lajos Zsom
Fresenius Medical Care Hungary, Cegléd, Hungary
Eva Csongradi
Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Karim M. Soliman
Department of Surgery, Division of Transplant, Medical University of South Carolina, Charleston, SC, USA
Usama A. Sharaf El Din
Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
AbstractBackground 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
