Effect of combined treatment of oral sorbent with protein-restricted diet on change of reciprocal creatinine slope in patients with CRF.
BACKGROUND
Low-protein diet (LPD) is one therapy and AST-120, an oral carbon adsorbent, is the other therapy to reduce blood levels of indoxyl sulfate in patients with chronic renal failure (CRF). Based on the different mechanisms of reducing indoxyl sulfate levels, the addition of AST-120 to an LPD was investigated.


METHODS
Seven hundred twenty-two patients with chronic glomerulonephritis (CGN) and 162 patients with diabetic nephropathy (DN) were stratified by protein intake: less than 0.50 g/kg/d (0.50-g/kg/d group), 0.51 to 0.65 g/kg/d (0.65-g/kg/d group), and 0.66 to 0.80 g/kg/d (0.80-g/kg/d group). To analyze the effect of combined AST-120 therapy (6 g/d) in patients on LPD therapy, the slope of the reciprocal of serum creatinine (1/Cr slope), which represents progression of CRF, was applied.


RESULTS
(1) In patients with CGN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.50-g/kg/d (n = 152), 0.65-g/kg/d (n = 318), and 0.80-g/kg/d (n = 252) groups changed significantly from -430 x 10(-5) to -83 x 10(-5), -333 x 10(-5) to -102 x 10(-5), and -431 x 10(-5) to -116 x 10(-5) dL/mg/wk. (2) In patients with DN, the addition of AST-120 with an LPD was as follows: the 1/Cr slope in the 0.65-g/kg/d (n = 74) and 0.80-g/kg/d (n = 68) groups changed significantly from -602 x 10(-5) to -125 x 10(-5) and -646 x 10(-5) to -185 x 10(-5) dL/mg/wk.


CONCLUSIONS
It is suggested that the addition of AST-120 to a mild LPD provides the comparable effect with a strict LPD in the point of suppressing the progress of CRF.
Sanaka
Tsutomu
T
Department of Nephrology and Blood Purification, Daini Hospital Medical Center, Tokyo Women's Medical University, Tokyo 116-8567, Japan. sanakakc@dnh.twmu.ac.jp
Fujimoto
Kumiko
K
Niwayama
Jun
J
Nishimura
Hideki
H
Naito
Takashi
T
Higuchi
Chieko
C
Akizawa
Tadao
T
Koide
Keizo
K
Koshikawa
Shozo
S
D000284:Administration, Oral; D000327:Adsorption; D002244:Carbon / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood*; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy; D018753:Diet, Protein-Restricted / Q000379:methods*; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000188:drug therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage*
D010087:Oxides; D002244:Carbon; C040896:AST 120; D003404:Creatinine