What question did this study set out to answer?

The aim is to evaluate if trimetazidine alone or with allopurinol decreases the risk of contrast-associated acute kidney injury during elective PCI.

January 24, 2026European Journal of Clinical Pharmacology1 citationsOpen Access

Trimetazidine and allopurinol for the prevention of Contrast-associated acute kidney injury in elective percutaneous coronary intervention: a randomized controlled trial

NANissa J. AliEgyptian Government NBNaglaa Samir BazanCairo University HMHatem Hossam MowafyCairo University

Key Result

The TMZ-allopurinol combination showed a non-significant trend towards reduced CA-AKI incidence compared to control, with 48 h rates of 16.28%, 20.45%, and 28.57%.

Key Points

The aim is to evaluate if trimetazidine alone or with allopurinol decreases the risk of contrast-associated acute kidney injury during elective PCI.
Randomized 129 patients undergoing elective PCI into three groups based on hydration and drug interventions.
Group 1 received IV isotonic saline with trimetazidine and allopurinol, Group 2 with trimetazidine only, Group 3 as a control with saline only.
Primary outcome measured was the incidence of CA-AKI at 24 and 48 hours post-PCI.
Risk stratification was performed using Mehran and ACEF scores.
Group 1 showed a non-significant reduction in CA-AKI rates compared to Groups 2 and 3 at both time points.
CA-AKI incidence was 4.65%, 4.55%, and 9.52% at 24 hours, and 16.28%, 20.45%, and 28.57% at 48 hours for Groups 1, 2, and 3, respectively.
SGLT2 and DPP-4 inhibitor users demonstrated lower creatinine rises compared to non-users, indicating potential nephroprotection.

Structured PICO

Does the addition of trimetazidine and allopurinol to standard IV hydration reduce the incidence of contrast-associated acute kidney injury in patients undergoing elective PCI?

Population

129 adults (aged 18-80 years) undergoing elective percutaneous coronary intervention (PCI) with eGFR > 60 ml/min/1.73 m2, classified as low-to-moderate risk by ACEF and Mehran scores.

Intervention

Group 1: Trimetazidine 35 mg oral once daily (before and up to 24 h post-PCI) + allopurinol 300 mg oral once daily (5 hours before and the day after) + IV isotonic saline. Group 2: Trimetazidine 35 mg oral once daily + IV isotonic saline.

Comparator

Control group receiving IV isotonic saline only (0.9% sodium chloride at 1 mL/kg/hour starting 3-4 h before and up to 24 h after PCI).

Outcome

Incidence of contrast-associated acute kidney injury (CA-AKI) at 24- and 48-hour post-PCI (defined as a relative increase in CrCl or Scr of at least 25% above baseline or an absolute rise in Scr of at least 0.5 mg/dl).safety

The addition of trimetazidine and allopurinol to standard hydration did not significantly reduce contrast-associated acute kidney injury in low-to-moderate risk patients undergoing elective PCI.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Purpose Contrast-associated acute kidney injury (CA-AKI) is a significant concern following percutaneous coronary intervention (PCI). This study assessed whether adding trimetazidine (TMZ) or TMZ/allopurinol to standard hydration reduces CA-AKI among elective PCI patients. Methods 129 patients undergoing elective PCI were randomized into three groups: Group 1 received (IV isotonic saline + TMZ + allopurinol), Group 2 received (IV isotonic saline + TMZ), and Group 3 (control) received (IV isotonic saline only). The primary outcome was the incidence of CA-AKI at 24- and 48-hour post-PCI. Risk was stratified using the Mehran and the Age, Creatinine, and Ejection Fraction (ACEF) scores. Results Group 1 demonstrated a non-significant reduction in CA-AKI incidence compared with Groups 2 and 3 (24 h: 4.65%, 4.55%, and 9.52%; 48 h: 16.28%, 20.45%, and 28.57%; p > 0.05). All patients were classified as low–moderate risk by ACEF and Mehran scores, neither of which predicted CA-AKI. At 48 h, SGLT2 inhibitors users demonstrated a smaller rise in creatinine compared with non-users (–0.04 ± 0.158 mg/dL vs. 0.096 ± 0.237 mg/dL, p < 0.05), as did DPP-4 inhibitor users (–0.05 ± 0.217 mg/dL vs. +0.098 ± 0.237 mg/dL, p < 0.05). Diuretics were associated with greater increases ( p < 0.05). Conclusion The TMZ–allopurinol combination showed a favorable but non-significant trend toward reducing CA-AKI, while ACEF and Mehran scores demonstrated limited predictive value. Improved risk-stratification tools and larger studies in higher-risk patients are needed. SGLT2 and DPP-4 inhibitors showed smaller creatinine increases, suggesting possible nephroprotection, but this remains exploratory.

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