Febuxostat Cuts CI-AKI Risk in CKD

implications of nonadherence and the true reasons and implications, patients’ access to kidney transplantation may be impeded.”

Researchers can provide useful information to fill the gap, she said, by linking clearly defined and internally valid be siloed in different (and oftentimes disconnected) specialties. “

As for the greater cardiac benefit observed with tadalafil, Dr Ha said, “We speculate that this may be due to differences in pharmacokinetics, with tadalafil offering more specific inhibition of PDE5 enzymes with less cross reactivity, as well as a longer duration of efficacy. As such, this may promote medication compliance, particularly in patients with both ED and CAD. However, our results are preliminary, and as such, we cannot definitely conclude that clinicians should preferentially prescribe tadalafil until additional research is performed.”

The study population included 12,214 sildenafil users, 6751 tadalafil users, and 22,321 men who received no treatment. Dr Ha’s team performed propensity-score matching using baseline and Transplant Registry. The study population included 5904 recipients of living-donor kidneys, 9316 recipients of brain-dead donor kidneys, and 2359 recipients of kidneys donated following circulatory death. The investigators followed patients for a median of 7.3 years.

SGF in recipients of living-donor kidneys increased their risk for graft failure and death by 1.5- and 1.6-fold, respectively, in adjusted analyses, Dr Venkataraman reported. Among recipients of kidneys from brain-dead donors, SGF significantly increased the

McDonnell acknowledged that providers are constrained by time and resources. “Affording social workers and other dialysis providers the time and resources needed to support these patients may require reallocating tasks and providing for additional time and staff resources, prioritizing interventions that uncover and address the real reasons for patient nonadherence. Such efforts and interventions could help improve adherence among patients, and in the long term, increase rates of patient referral, waitlisting, and transplant receipt.” ■ comorbidities of hypertension, ischemic heart disease, cerebral infarction, diabetes, and hyperlipidemia.

The association between PDE5i therapy and lower MACE risk also was demonstrated in a retrospective, observational cohort study published in The Journal of Sexual Medicine in January. The study, by Robert A. Kloner, MD, PhD, of Huntington Medical Research Institutes in Pasadena, California, and colleagues, included 72,498 men with ED and no prior MACE within the previous year identified using a claims database. Of these, 23,816 had at least 1 claim for a PDE5i (exposed group) and 48,682 did not (unexposed group). On multivariable analysis, the exposed group had a significant 13% lower risk for MACE, 39% lower risk for cardiovascular death, and 25% lower risk for overall mortality compared with the unexposed group. ■ risk for graft failure by nearly 1.2-fold, but did not influence patient survival. SGF was not significantly associated with graft or patient survival among recipients of kidneys from circulatorydeath donors.

DGF significantly increased the risk for graft failure by approximately 2.1-, 1.4-, and 1.7-fold in recipients of kidneys from living donors, brain-dead donors, and circulatory-death donors, respectively, and significantly increased the risk for patient death by approximately 2.0-, 1.4-, and 1.5-fold, respectively. ■

Febuxostat reduces the risk for contrast-induced acute kidney injury (CI-AKI) in patients with stage 3 chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. In a trial, investigators randomly assigned 120 patients to receive traditional treatment with intravenous hydration and N -acetylcysteine with and without the addition of febuxostat. Each group had 60 patients. The intervention group received 80 mg febuxostat 6-18 hours before and after PCI and stenting with 24 hours in between doses.

CI-AKI occurred in a significantly lower proportion of the febuxostat than control group: 11.7% vs 25.0%, Nahla Mohamed Teama, MD, of Ain Shams University in Cairo, Egypt, and colleagues reported in BMC Nephrology. They noted that no serious adverse reactions occurred in the febuxostat group.

Serum uric acid levels did not change significantly from baseline to 3-5 days after contrast exposure in either group, but urea and serum creatinine levels rose significantly higher in the control group. In multivariate analysis, only febuxostat nonuse, baseline serum creatinine, and high Mehran score predicted contrastinduced AKI. The Mehran Score gives points for hypotension, use of an intraaortic balloon pump, congestive heart failure, age older than 75 years, anemia, diabetes, contrast media volume, and estimated glomerular filtration rate less than 60 mL/min/1.73m2

Despite the limited studies regarding the use of febuxostat to protect against CI-AKI among CKD patients, “we recommend its use in CKD stage 3 patients, especially patients with hyperuricemia,” the investigators wrote. “We recommend using risk scores for acute kidney injury before giving contrast to CKD patients to stratify the patients and individualize contrast type, volume and preventive measures according to the results of these scores.” ■