Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt.
Ren Fail. 2023 Dec;45(1):2194434. doi: 10.1080/0886022X.2023.2194434.
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.
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 2 received allopurinol, the 3 group received linagliptin, and the 4 received both allopurinol and linagliptin. Post-procedure follow-up for kidney functions was conducted for 2 weeks in all patients.
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 ( < 0.02 and <0.03, respectively). None of the post-contrast AKI cases required dialysis.
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.
患有糖尿病肾病（DKD）的患者发生造影剂后急性肾损伤（AKI）的风险增加。接受二肽基肽酶 4 抑制剂（DPP4I）治疗的糖尿病患者发生 AKI 的倾向较低。我们推测，利拉利汀作为单一药物或与别嘌醇联合使用，可能会降低基础 DKD 的 3-5 期慢性肾脏病（CKD）患者造影后 AKI 的发生率。
在符合本研究条件的 951 名 DKD 患者中，有 800 名患者愿意签署知情同意书。他们被随机分为 4 组，每组接受 2 天的预防治疗，分别在造影前后。第一对照组接受 N-乙酰半胱氨酸和生理盐水，第二组接受别嘌醇，第三组接受利拉利汀，第四组接受别嘌醇和利拉利汀。所有患者在术后 2 周内进行肾功能随访。
第 1 至 4 组分别有 20、19、14 和 8 例患者发生造影后 AKI。利拉利汀和别嘌醇均不比 N-乙酰半胱氨酸和生理盐水单独使用更有效。然而，两种药物的联合使用提供了统计学上显著的肾脏保护作用：第 4 组的造影后 AKI 明显低于第 1 组和第 2 组（分别为<0.02 和<0.03）。没有一例造影后 AKI 需要透析。
在接受造影剂的 DKD 患者中，利拉利汀和别嘌醇联合使用可能提供造影后 AKI 的保护作用。需要进一步的研究来支持这一观点。
CLINICALTRIALS.GOV：NCT03470454。
