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This study assessed whether adding trimetazidine (TMZ) or TMZ\/allopurinol to standard hydration reduces CA-AKI among elective PCI patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>129 patients undergoing elective PCI were randomized into three groups: Group 1 received (IV isotonic saline\u2009+\u2009TMZ\u2009+\u2009allopurinol), Group 2 received (IV isotonic saline\u2009+\u2009TMZ), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Group 1 demonstrated a non-significant reduction in CA-AKI incidence compared with Groups 2 and 3 (24\u00a0h: 4.65%, 4.55%, and 9.52%; 48\u00a0h: 16.28%, 20.45%, and 28.57%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). All patients were classified as low\u2013moderate risk by ACEF and Mehran scores, neither of which predicted CA-AKI. At 48\u00a0h, SGLT2 inhibitors users demonstrated a smaller rise in creatinine compared with non-users (\u20130.04\u2009\u00b1\u20090.158\u00a0mg\/dL vs. 0.096\u2009\u00b1\u20090.237\u00a0mg\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), as did DPP-4 inhibitor users (\u20130.05\u2009\u00b1\u20090.217\u00a0mg\/dL vs. +0.098\u2009\u00b1\u20090.237\u00a0mg\/dL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Diuretics were associated with greater increases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The TMZ\u2013allopurinol 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00228-025-03985-6","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:20:09Z","timestamp":1769041209000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trimetazidine and allopurinol for the prevention of Contrast-associated acute kidney injury in elective percutaneous coronary intervention: a randomized controlled trial"],"prefix":"10.1007","volume":"82","author":[{"given":"Nourhan Osama","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8930-4697","authenticated-orcid":false,"given":"Naglaa Samir","family":"Bazan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem Hossam","family":"Mowafy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed E.A.","family":"Abdelrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2259-9686","authenticated-orcid":false,"given":"Hadeer S.","family":"Harb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"issue":"16","key":"3985_CR1","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.1093\/eurheartj\/ehr494","volume":"33","author":"E Seeliger","year":"2012","unstructured":"Seeliger E, Sendeski M, Rihal CS, Persson PB (2012) Contrast-induced kidney injury: mechanisms, risk factors, and prevention. 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