Management of contrast‐induced nephropathy in hyperuricaemic patients undergoing angiography or angioplasty: a systematic review

Aim In hyperuricaemic patients undergoing contrast procedures, although the mechanisms linking hyperuricaemia and contrast‐induced nephropathy (CIN) remain uncertain, effective prevention of CIN is essential. This review aimed to analyse drug or therapeutic intervention approaches used to mitigate CIN in patients with hyperuricaemia. Data sources PubMed, Embase, Scopus and Cochrane Library were searched between 2014 and 2025 for studies that included adult patients undergoing angioplasty or angiography and received any drug or therapeutic intervention to prevent CIN and included hyperuricaemia as a comorbidity. Study selection Randomised controlled trials (RCTs), published in English, that reported the incidence of CIN based on a study‐specific definition were included. Only RCTs were included, with all other study designs excluded. The Risk of Bias (RoB) 2 tool was utilised to ascertain RoB. This review was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) 2020 statement. Results Of the 78 initially identified studies, ten were removed for duplication, and after title and abstract screening, 51 studies were excluded. Of the remaining 17 studies, seven full text versions could not be retrieved and subsequently excluded. After assessing against the inclusion criteria, three studies were included in the analysis. Two (66.6%) of the studies adopted the same definition of CIN, and the average total incidence of CIN from all studies was 13.1%. Two studies assessed the use of febuxostat as an intervention, and all three studies used intravenous hydration in their respective control arm. Prevention strategies included intravenous hydration, febuxostat, oral hydration and N ‐acetylcysteine. Conclusion Febuxostat showed potential in preventing CIN in high‐risk hyperuricaemic patients with chronic kidney disease, but evidence was limited and heterogeneous across studies. Our review was limited to only three RCTs with heterogeneous interventions and variable patient populations. The reported 13.1% for total incidence of CIN should be viewed as a descriptive summary of risk rather than a clinically generalizable rate, underscoring the need for larger, standardised and methodologically rigorous trials to define optimal prophylactic strategies.