Abstract Background: Contrast-induced nephropathy (CIN) is a significant cause of acute kidney injury, particularly in patients with pre-existing renal issues. Its pathophysiology involves oxidative stress. Allopurinol, a xanthine oxidase inhibitor, may protect the kidneys by mitigating this damage. This meta-analysis evaluates the efficacy of allopurinol with intravenous hydration versus intravenous hydration alone in preventing CIN. Methods: Following PRISMA guidelines, PubMed, Google Scholar, Cochrane CENTRAL, and Herdin databases were searched for randomized controlled trials comparing allopurinol with intravenous hydration to intravenous hydration alone in patients undergoing coronary procedures. Primary outcome was CIN incidence, with secondary outcomes including serum creatinine, uric acid, BUN, and eGFR changes. Risk of bias was assessed using Cochrane's tool, and analysis used a random effects model. Results: Analysis of five randomized controlled trials showed that allopurinol significantly reduced the incidence of contrast-induced nephropathy (CIN) by 47% (95% CI 0.32–0.87, p = 0.01). This effect remained consistent even after sensitivity analysis, showing a 58% reduction (RR = 0.42, 95% CI 0.22–0.81, p = 0.01). Allopurinol also significantly decreased serum creatinine (MD = -0.08, 95% CI -0.11, -0.04, p = 0.0001). However, the results for uric acid were inconsistent due to high heterogeneity, and there was limited data on BUN and eGFR, which prevented definitive conclusions about these outcomes. Conclusion: Allopurinol and hydration effectively reduce the risk of CIN, suggesting improved renal outcomes, particularly for high-risk patients in resource-limited settings where allopurinol is a cost-effective and accessible option. Further research is warranted.
Dizon et al. (Thu,) studied this question.